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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372005946
Report Date: 02/27/2020
Date Signed: 02/27/2020 05:48:45 PM



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
12/06/2019 and conducted by Evaluator Selina Siao
COMPLAINT CONTROL NUMBER: 51-CC-20191206153349
FACILITY NAME:ST. COLUMBA PRESCHOOLFACILITY NUMBER:
372005946
ADMINISTRATOR:PATRICIA GILSDORFFACILITY TYPE:
850
ADDRESS:3365 GLENCOLUM DRIVETELEPHONE:
(858) 279-0161
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:60CENSUS: 10DATE:
02/27/2020
UNANNOUNCEDTIME BEGAN:
04:35 PM
MET WITH:Fiona Bloemker/Preschool Teacher TIME COMPLETED:
05:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to safeguard children's records
Admission Agreement is not in the children's records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst, Selina Siao conducted an unannounced inspection to deliver the above complaint findings. The initial inspection and tour of the preschool classrooms was conducted by Analyst Siao on 12/16/2019.
Throughout the course of investigation, interviews were conducted with several staff members and several daycare parents. Children’s records were reviewed during the initial inspection and today. One of the child's identification and emergency form was not in the file on 12/16/2019 and there is conflicting information if the form was ever completed at the time of enrollment. All of the files that were reviewed have the admission agreement form signed by the parents. Based on information gathered, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.
Appeal Rights (1/16) were discussed and provided. Signature at the bottom of this report confirms receipt. Notice of Site Visit was posted during this visit and will remain posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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