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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376600162
Report Date: 12/28/2020
Date Signed: 12/28/2020 02:34:32 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
07/16/2020 and conducted by Evaluator Tyra Block
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20200716135715
FACILITY NAME:MISSION NAZARENE PRESCHOOLFACILITY NUMBER:
376600162
ADMINISTRATOR:ANGELA SIROTAFACILITY TYPE:
850
ADDRESS:4750 MISSION GORGE PLACETELEPHONE:
(619) 287-4900
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:114CENSUS: 0DATE:
12/28/2020
UNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Paul SlaterTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not adequately supervising children in care
Child's injury not reported to parent timely
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/28/20, Licensing Program Analyst (LPA) Tyra Block, made an unannounced complaint tele-inspection via Zoom due to COVID-19 State of Emergency to deliver the complaint finding on the above allegations. LPA met with Pastor Paul Slater and made him aware of the reason for today’s inspection. Current census is 0 due to winter break.

During the investigation, LPA reviewed records and interviewed facility staff and parents. It was alleged that on several occasions child #1 was injured by his peer child #2 due to inadequate supervision by staff and the parent was not notified timely of an injury.There is insufficient evidence and/or witnesses to corroborate the above allegations. LPA was unable to determine whether the allegations are valid.

Based on the information obtained the allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Appeal Rights (1/16) were discussed and provided by email. A reply will be sent to acknowledge receipt of these rights and licensing report. Notice of Site Visit was provided and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2020
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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