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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376600285
Report Date: 08/06/2019
Date Signed: 08/06/2019 02:33:18 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
05/10/2019 and conducted by Evaluator Selina Siao
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20190510134440
FACILITY NAME:ST. PAUL'S COMMUNITY CARE CENTERFACILITY NUMBER:
376600285
ADMINISTRATOR:CONNIE RODRIGUEZFACILITY TYPE:
830
ADDRESS:328 MAPLE STREETTELEPHONE:
(619) 239-6900
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY:35CENSUS: 18DATE:
08/06/2019
UNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Vanessa Garcia/DirectorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility failed to document all injuries in the child's record and notify parent after a child sustained bite mark
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Selina Siao conducted an unannounced inspection to deliver the above complaint finding. The initial inspection was conducted by Analyst Siao on 05/17/2019 and with a follow up inspection on 07/31/2019. Throughout the course of investigation, records were reviewed and interviews were conducted with several staff members and several daycare parents.
During the investigation, facility failed to provide written documentation of the child's biting incident that happened on April 19, 2017 to parent. Documentation of the incident is not available at the facility. Based on LPA’s observations, interviews that were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED, California Code of Regulations, (Title 22, 101226 (a)(2) is being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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 20-CC-20190510134440
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. PAUL'S COMMUNITY CARE CENTER
FACILITY NUMBER: 376600285
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2019
Section Cited
CCR
101226(a)(2)
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In the case of less serious injuries including, but not limited to, minor cuts, scratches and bites from other children requiring 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.
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Director stated that she will providing training with staff members on the importance of documention of all incidents. Facility will be placing a copy of the incident report in the child's file. The training agenda along with the staff members sign in
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This requirement was not met as evidence by: Based on information obtained and staff interviews. Facility failed to document at least one biting incident that happened to a child on their arm on 04/19/2017. This poses a potential Health and Safety risk to the clients in care.
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sheet will be submitted to Analyst by 09/02/2019.
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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: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC9099 (FAS) - (06/04)
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