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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372005946
Report Date: 03/24/2020
Date Signed: 03/24/2020 01:55:00 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
01/09/2020 and conducted by Evaluator Samantha Salunga
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20200109141831
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: 0DATE:
03/24/2020
ANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:LORI JIANNUZZITIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Facility failed to report an unusual incident.
A child left the facility unsupervised.
Facility operating out of ratio.
INVESTIGATION FINDINGS:
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On 03/24/2020 at 12:05pm, Center Director Lori Jiannuzzi met with Licensing Program Analyst (LPA) Samantha Salunga at the San Diego Regional Office for the purpose of obtaining complaint findings for the above allegations. Facility is temporary closed until further notice, due to COVID-19.

Based upon information gathered through interviews conducted with staff, parents and children and supporting documents, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. It was confirmed via interviews that on 08/29/19, Child #1 walked out of his classroom and was found outside of the preschool classroom alone, without adult supervision for approximately 1-2 minutes. This incident was not reported to Community Care Licensing (CCL). It was also confirmed via interviews and obtained documentation that on 01/08/2020, facility operated out of ratio. There were two teachers supervising a total of 26 children. California Code of Regulations, (Title 22, Division & Chapter 1) are being cited on the attached LIC 9099D. See 9099C for continuation...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
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-20200109141831
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: ST. COLUMBA PRESCHOOL
FACILITY NUMBER: 372005946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2020
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time.

This requirement was not met as evidenced by;
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Director stated she will conduct a staff training to discuss the importance of visual supervision and maintaining it at all times of all children.
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Based on information obtained via interviews, it has been confirmed that on 08/29/19, Child #1 was found outside of the preschool classroom alone without adult supervision for approixmately 1-2 minutes. This poses a Potential Health and Safety risk to the clients in care.
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Director stated that she will write up an agenda and provide LPA with the agenda and completed sign in sheet after the staff meeting has been conducted. Due to COVID19, date of staff meeting is unknown. Director stated she will provide LPA with an update by POC due date.
Type B
04/03/2020
Section Cited
CCR
101212(d)(1)(c)
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A report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by;
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This incident occurred prior to Director's employment at the facility. Director stated she is knowledgeable of what needs to be reported to CCL and will add reporting requirements to the staff agenda. Director stated she will provide LPA with an update by POC due date.
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Based on information obtained via interviews, facility did not report to CCL an unusual incident that occurred on 08/29/19, where Child #1 was found outside of the preschool classroom alone without adult supervision. This poses a Potential Health and Safety risk to the clients in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 51-CC-20200109141831
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: ST. COLUMBA PRESCHOOL
FACILITY NUMBER: 372005946
VISIT DATE: 03/24/2020
NARRATIVE
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Appeal Rights (1/16) were discussed and provided to Director. Director's signature at the bottom of this report confirms receipt. Director stated she will post Notice of Site Visit (NOV) upon returning to the facility and will take a picture of it posted to LPA via email. NOV shall remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 51-CC-20200109141831
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: ST. COLUMBA PRESCHOOL
FACILITY NUMBER: 372005946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2020
Section Cited
CCR
101216.3(a)
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Teacher – Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

This requirement was not met as evidenced by;
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Director stated she will conduct an all staff meeting to discuss "30 Minute Count" and schedules to ensure incident will not happen again. Director will submit proof of sign in sheet and agenda to LPA by POC due date.
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Based on interviews conducted and reviewed documentation, facility operated out of ratio on 01/08/20. This poses a Potential Health and Safety risk to the clients in care.
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Director stated she will provide LPA with an update by POC due date.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
LIC9099 (FAS) - (06/04)
Page: 5 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
01/09/2020 and conducted by Evaluator Samantha Salunga
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20200109141831

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: 0DATE:
03/24/2020
ANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:LORI JIANNUZZITIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Staff member wiped child's butt with soiled toilet paper.
No working telephone on site.
Staff falsified sign in and sign out sheets.
INVESTIGATION FINDINGS:
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THIS IS AN AMENDED REPORT FROM AN ORIGINAL REPORT DATED, 03/24/2020.

On 03/24/2020 at 12:05pm, Center Director Lori Jiannuzzi met with Licensing Program Analyst (LPA) Samantha Salunga at the San Diego Regional Office for the purpose of obtaining complaint findings for the above allegations. Facility is temporary closed until further notice, due to COVID-19.

Throughout the investigation, LPA interviewed staff, children, and day care parents. LPA received conflicting statements throughout the investigation regarding the above allegations. Based on the information obtained during interviews and observations, it is determined that although the above allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Appeal Rights (1/16) were discussed and provided to Director. Director's signature at the bottom of this report confirms receipt. Director stated she will post Notice of Site Visit (NOV) upon returning to the facility and will take a picture of it posted to LPA via email. NOV shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5