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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372000455
Report Date: 01/24/2023
Date Signed: 01/24/2023 01:00:22 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
10/07/2022 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20221007161405
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: 56DATE:
01/24/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer GoinsTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not notify day care child’s parent of incident.
INVESTIGATION FINDINGS:
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On 01/23/2023 at 11am, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced inspection to deliver complaint findings for the above allegations. Upon arrival, LPA met with Co-Director, Jennifer Goins, and proceeded to tour the facility. LPA observed a total of 56 children with 12 staff members. LPA discussed the purpose of the inspection with Ms. Goins and explained how the Department conducted a full investigation

It was alleged a daycare child (C1) sustained an unexplained injury (fractured pinky finger) while in care and that the parent was not notified by the staff of the incident. During the course of the investigation, the Department conducted interviews with facility staff, day care parents and children. In addition, medical records and video footage were also obtained and reviewed. Information obtained confirmed that although C1 reported that their hand hurt after they slid down the playground slide, it could not be definitively determined that they fractured their finger during that specific incident. (See 9099-C for continuation)
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: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
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
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
10/07/2022 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20221007161405

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: 56DATE:
01/24/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jennifer GoinsTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Day care child sustained unexplained fracture while in care.
Staff did not prevent day care children from hitting another day care child.
Personal Rights- Child’s personal belongings were not safe guarded.
Food Services- Child was not provided enough food while in care.
INVESTIGATION FINDINGS:
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On 01/24/2023 at 11am, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced inspection to deliver complaint findings for the above allegations. Upon arrival, LPA met with Co-Director, Jennifer Goins, and proceeded to tour the facility. LPA observed a total of 56 children with 12 staff members. LPA discussed the purpose of the inspection with Ms. Goins and explained how the Department conducted a full investigation.

It was alleged a daycare child (C1) sustained an unexplained injury (fractured pinky finger) while in care. During the course of the investigation, the Department conducted interviews with facility staff, day care parents and day care children. In addition, medical records and video footage were also obtained and reviewed. Information obtained confirmed that although C1 reported that their hand hurt after they slid down the playground slide, it could not be definitively determined that they fractured their finger during that specific incident. With the exception of C1’s initial cry once they slid down the slide, C1 did not exhibit any pain or discomfort until C1’s parent picked them up at the end of the day. (See 9099-C for continuation)
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: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 51-CC-20221007161405
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: 01/24/2023
NARRATIVE
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C1 was observed to be washing their hands normally, pulling on a paper towel, and using their hands throughout the day without any apparent discomfort or indication of being hurt, which lead staff to believe there was no serious injury that would require an immediate report to the parents. A review of the medical records indicated that on the day of the incident, C1 was initially diagnosed with a “likely contusion” (bruise). Two days later, C1 was seen by an orthopedic doctor and diagnosed C1 with a “new upper extremity fracture.” Information obtained from staff confirmed that appropriate ratio and supervision was provided during the incident.

It was also alleged that staff did not safeguard C1’s personal belongings. Based on interviews with staff, reporting party and a review of the child’s record, it was determined that there were no clear instructions provided for staff to safeguard C1’s belongings.

Regarding the child being hit/bullied by other children, the staff and children interviews revealed that there was no indication or concern of children being bullied or hit by other children without staff addressing the behavior appropriately.

With regard to the child not being provided sufficient food, staff and parent interviews confirmed that the parents/guardians provide their own child(ren)’s food while in care. The child in question brought their own meals which according to multiple staff, were often too much for a child to eat in its entirety. Information obtained from staff also indicated that they strongly encourage the children to eat their food and they cannot force the children to eat if they don’t want to eat everything the parents provide. Parent interviews indicated that they did not have any concern relating to their children not eating enough while in care.

Finally, the majority of parents interviewed stated that they had no concern related to the overall care and supervision that the staff provide to their child(ren).

Based on the all the information obtained throughout the investigation regarding the above allegations, the Department found the allegations to all be unsubstantiated. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove that any of alleged violations occurred. Exit interview was conducted with Co-Director. 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: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 51-CC-20221007161405
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: 01/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2023
Section Cited
CCR
101226(a)(2)
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Health-Related Services... assessment and/or administration of first aid by staff, the licensee shall document the injury in the child's record and notify the child's authorized representative of the nature of the injury when the child is picked up from the center. This was not met as evidenced by;
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Co-Director stated that ever since the incident occurred, there have been multiple staff training's conducted, with the last one being (12/12/22) discussing reporting requirements for licensing and internal procedures, and daily child assessments.
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Based on information obtained via interviews and reviewed documentation, it was confirmed that facility did not document the possible injury/incident that occurred when C1 reported that their hand hurt after sliding down the slide. C1's hands were assessed by multiple staff throughout the day, however the child's authorized representative was not notified. This poses a Potential Health and Safety risk to the clients in care.
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Co-Director has already submittedto LPA proof of staff training and agenda. Co-Director also provided LPA during inspection a list of everyone who attended the training. Deficiency is cleared today.
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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: 01/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 51-CC-20221007161405
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: 01/24/2023
NARRATIVE
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(continued)

With the exception of C1’s initial cry once they slid down the slide, C1 did not exhibit any pain or discomfort until C1’s parent picked them up at the end of the day. C1 was observed to be washing their hands normally, pulling on a paper towel, and using their hands throughout the day doing daily normal activities without any apparent discomfort or indication of being hurt, which lead staff to believe there was no serious injury that would require an immediate report to the parents. However, due to C1 requiring assessment of their hand immediately after the incident by staff, the facility should have documented the possible injury/incident in the child's record and notify the child's authorized representative when the child was picked up from the center.

Based on the all the information obtained throughout the investigation regarding the above allegation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. See 9099D for California Code of Regulations, (Title 22, Division & Chapter 1) for cited deficiency.

Exit interview was conducted with Co-Director. 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: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5