376600618-7-7-2022-51-CC-TDAL-CGRT9H-20220728143159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376600618
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:30:09 PM

Substantiated

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
06/14/2022 and conducted by Evaluator Tyra Block

PUBLIC

COMPLAINT CONTROL NUMBER: 51-CC-20220614115829

FACILITY NAME:	ST. ANDREW'S LUTHERAN PRESCHOOL		FACILITY NUMBER:	376600618
ADMINISTRATOR:	STEPHANIE ALEXANDER		FACILITY TYPE:	850
ADDRESS:	8350 LAKE MURRAY BOULEVARD		TELEPHONE:	(619) 469-3531
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92119
CAPACITY:	24	CENSUS: 7	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Pastor Sarah and Sherry Smith		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Daycare child was left unattended

INVESTIGATION FINDINGS:

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On 7/7/22, Licensing Program Analyst (LPA), Tyra Block made an unannounced complaint visit for the complaint received on 6/14/22 for the purpose of continuing the investigation of the above referencednallegation. Present today were 3 staff and 7 children. LPA was greeted by Pastor Sarah who met with LPA briefly then had to leave. LPA met with teachers Sherry Smith and Linda Tello. This incident was also self-reported.
During the investigation LPA also interviewed parents and reviewed documentation. Based on interviews and record review, the above allegation is found to be SUBSTANTIATED. The allegation is valid because the preponderance of the evidence has been met. The deficiency is being cited on the attached LIC 9099D. The Notice of Site Visit was provided, and LPA advised it must remain posted for 30 days. An exit interview was conducted with Meri Jo Petrivelli..
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 was provided along with Parebt Notification Requirements.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20220614115829

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. ANDREW'S LUTHERAN PRESCHOOL	FACILITY NUMBER: 376600618
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/07/2022 Section Cited CCR 101229(a)(1	1 2 3 4 5 6 7	101229(a)(1)-Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evodence by:	1 2 3 4 5 6 7	Licensee immediately implemented a new drop-off/ sign-in procedure to ensure visual supervison at all times by dropping off at playground area. Also, a new staff member has been hired with a specialization in Special Needs that will begin 7/11/22. POC cleared.
	8 9 10 11 12 13 14	On 6/14/22, a child was left unattended after drop off and allowed to wander away to the parking lot. This poses an immediate risk to the health and safety of children.	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: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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