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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372000455
Report Date: 11/18/2022
Date Signed: 11/18/2022 12:32:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2022 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20220811141049
FACILITY NAME:PILGRIM DAY CARE CENTERFACILITY NUMBER:
372000455
ADMINISTRATOR:J. GOINS & C. O'CONNORFACILITY TYPE:
850
ADDRESS:2020 CHESTNUT AVENUETELEPHONE:
(760) 729-4464
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:110CENSUS: 42DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:J. Goins & C. O'ConnorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff did not seek medical attention to day care child
Parent was not notified of injury
INVESTIGATION FINDINGS:
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On 11/18/22 at 11:30pm, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced inspection to deliver complaint findings for the allegations listed above. Upon arrival, LPA met with Co-Director's, and proceeded to tour the facility. LPA observed a total of 42 children with 11 staff members. LPA discussed the purpose of the inspection with Co-Director's and how the Department conducted a full investigation. It was alleged that the facility did not seek timely medical attention to a day care child (C1) who complained about his arm pain after being picked up by staff member (S1) on 07/21/22, and how C1’s parent was not notified until pick up time. The injury C1 sustained while in care was confirmed to be nursemaid’s elbow. During the course of the investigation, medical records were reviewed, and interviews were conducted with facility staff and day-care parents. Based on information obtained by the Department, it was determined that on 07/21/22, C1 sustained nursemaid’s elbow by S1 grabbing C1 in order to prevent him from falling down during an outburst. Facility did not take immediate action to seek medical treatment after the child had complained of pain after the incident occurred. Facility also did not notify C1’s parent/guardian of the injury until pick up time, which was around 12pm. The injury occurred around 10:20am.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 51-CC-20220811141049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2022
Section Cited
CCR
101226(b)
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7
Health-Related Services. The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary. This was not met as evidenced by
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Director stated that S1 resigned on 08/12/2022 and no longer works at the facility. In addition, Director stated she held a staff meeting on 08/15/2022 and 10/10/2022 to discuss and refresh their internal reporting procedures and what to
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 information obtained via interviews confirmed that the facility did not seek immediate medical treatment when C1 complained of arm pain after being picked up by S1. This injury C1 sustained was nursemaid elbow. This poses an Immediate Health and Safety risk to the clients in care.
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do when a child sustains an injury. LPA provided Director additional topics to discuss with staff such as Title 22 regulation sections 101226, 101212 and 101226.3. Director stated she will schedule another staff meeting to review the additional topics and provide LPA the date of the scheduled staff meeting and its agenda by COB 11/21/22.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 51-CC-20220811141049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
VISIT DATE: 11/18/2022
NARRATIVE
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The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 9099D.

A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given and reviewed with Co-Director's. Co-Director's shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Notice of Site Visit was provided at conclusion of visit and is to be posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 51-CC-20220811141049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PILGRIM DAY CARE CENTER
FACILITY NUMBER: 372000455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2022
Section Cited
CCR
101226(a)
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7
Health-Related Services. The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken. This was not met as evidenced by,
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Director stated that S1 resigned on 08/12/2022 and no longer works at the facility. In addition, Director stated she held a staff meeting on 08/15/2022 and 10/10/2022 to discuss and refresh their internal reporting procedures and what to do when a child sustains an injury.
8
9
10
11
12
13
14
information obtained via interviews confirmed that the facility did not notify C1’s parent of C1’s injury sustained child in care until pick up time which was around 12pm. Incident occurred around 10:20am. C1 complained of his arm being in pain soon after the injury occurred. This poses a potential Health and Safety risk to the clients in care.
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9
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12
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14
LPA provided Director additional topics to discuss with staff such as Title 22 regulation sections 101226, 101212 and 101226.3. Director stated she will schedule another staff meeting to review the additional topics and provide LPA a copy of the agenda and everyone who attended by COB on 12/23/2022.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2022 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20220811141049

FACILITY NAME:PILGRIM DAY CARE CENTERFACILITY NUMBER:
372000455
ADMINISTRATOR:J. GOINS & C. O'CONNORFACILITY TYPE:
850
ADDRESS:2020 CHESTNUT AVENUETELEPHONE:
(760) 729-4464
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:85CENSUS: 42DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:J. Goins & C. O'ConnorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injury to day care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/18/22 at 11:30PM, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced inspection to deliver complaint findings for the allegation listed above. Upon arrival, LPA met with Co-Director's, and proceeded to tour the facility. LPA observed a total of 42 children with 11 staff members. LPA discussed the purpose of the inspection with Co-Director's and how the Department conducted a full investigation. It was alleged a daycare child (C1) sustained nursemaids elbow caused by staff (S1). During the course of the investigation, medical records were reviewed, and interviews were conducted with facility staff and day-care parents. Based on interviews conducted by the Department, it was determined that the nursemaid’s elbow was sustained by S1 grabbing C1 in order to prevent him from falling down during an outburst. There was no malic or intent to cause injury to the child. S1 reacted to C1 falling and it caused injury. There is no violation of the child’s personal rights, therefore the above allegation is to be unsubstantiated. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. Exit interview was conducted with Co-Director's. Notice of Site Visit was provided at conclusion of visit and is to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5