376600162-3-22-2021-51-CC-TDAL-BZWSDW-20210409134745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376600162
Report Date: 03/22/2021
Date Signed: 03/22/2021 12:40:38 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
02/09/2021 and conducted by Evaluator Grace Curtis

COMPLAINT CONTROL NUMBER: 51-CC-20210209085111

FACILITY NAME:	MISSION NAZARENE PRESCHOOL		FACILITY NUMBER:	376600162
ADMINISTRATOR:	ANGELA SIROTA		FACILITY TYPE:	850
ADDRESS:	4750 MISSION GORGE PLACE		TELEPHONE:	(619) 287-4900
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	114	CENSUS: 43	DATE:	03/22/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Evelyn Kensel		TIME COMPLETED:	10:59 AM

ALLEGATION(S):

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Operating out of ratio.

INVESTIGATION FINDINGS:

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Covid-19 State of Emergency
On 3/22/21 at 10:30 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced inspection via Zoom to deliver the findings on the complaint allegation referenced above. Upon arrival LPA met with Director Evelyn Kensel and proceeded to tour the facility. There were 43 children present with 8 staff members. Appropriate ratios were observed. Staff members have the required background clearances and are associated to the facility.

The initial complaint investigation was conducted by LPA Curtis on 2/17/21. Throughout the course of investigation, interviews were conducted with the complainant, several employees and several parents. Facility records were obtained and reviewed. The information gathered indicates that a staff member was alone with 14 children for approximately 5 minutes in the Dolphin Classroom the morning of 2/8/21.

Based on interviews conducted by LPA and record reviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED, California Code of Regulations, Title 22, 101216.3(a) is being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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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Control Number 51-CC-20210209085111

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: MISSION NAZARENE PRESCHOOL	FACILITY NUMBER: 376600162
	VISIT DATE: 03/22/2021

NARRATIVE

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An exit interview was conducted with the Director. Appeal rights (LIC 9058 1/16) were discussed. A copy of this report as well as a copy of the appeal rights were emailed to the Director at the conclusion of the inspection. The Director will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 51-CC-20210209085111

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: MISSION NAZARENE PRESCHOOL	FACILITY NUMBER: 376600162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/02/2021 Section Cited CCR 101216.3(a)	1 2 3 4 5 6 7	101216.3 Teacher-Child Ratio: (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The director states the she will conduct a staff meeting to discuss teacher-child ratios. The director will submit a copy of the meeting sign in sheet and agenda to LPA via email by 4/2/21. The director also states that she will advise staff to notify the office when they reach 10 children in their classrooms so additional staff support can be sent to the class.
	8 9 10 11 12 13 14	Based on interviews conducted by LPA a staff member was alone with 14 children in the Dolphin Class on 2/8/21. Staff failed to ensure a ratio of one staff to 12 children. This poses a potential health and safety risk to childen in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC9099 (FAS) - (06/04)

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