376701024-12-1-2021-10-CC-CMAZ-C9WRH4-20211221120140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376701024
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:51:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Sumayya Habeebulla

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20211011153133

FACILITY NAME:	INFUSION CHRISTIAN PRESCHOOL		FACILITY NUMBER:	376701024
ADMINISTRATOR:	THELMA AVILEZ		FACILITY TYPE:	850
ADDRESS:	777 W FELICITA AVENUE		TELEPHONE:	(760) 746-5030
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	75	CENSUS: 39	DATE:	12/01/2021
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	THELMA AVILEZ		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not report incident to the authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Sumayya Habeebulla, Ana Noble, and Linda Almaraz arrived at the facility for the purpose of conducting a subsequent complaint visit, which includes concluding the investigation and delivering the investigation findings regarding the complaint investigation initiated on 10/19/21. LPAs met with Director Thelma Avilez and discussed the above allegation.

On 10/19/21 LPA Habeebulla conducted interviews with the Director and 5 staff members, all of whom are pertinent to this investigation. Along with interviews, the investigation revealed that:

The allegation is of staff not reporting the incident to the authorized representative. Based on the information obtained, LPAs cannot determine if staff reported the incident to the authorized representative in a timely manner.

See LIC9099-C for continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

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 10-CC-20211011153133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: INFUSION CHRISTIAN PRESCHOOL	FACILITY NUMBER: 376701024
	VISIT DATE: 12/01/2021

NARRATIVE

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Based on interviews, the parent of the subject child came to pick up a few minutes following the incident and the staff did not have adequate time to make a written report and provide to the parent. However information revealed through interviews indicate that staff provided a verbal report on the date of the incident. As per the reporting Party, the child’s last day of school was on 09/24/21 and an authorized representative was not provided with an ouch report for the incident on 09/23/21. Facility stated that they created an ouch report and it was on file during LPA’s initial visit, however, they were unable to obtain signatures for it from the subject child’s representative. Therefore based on the information gathered, and conflicting information obtained in this investigation the allegation is UNSUBSTANTIATED.

From the information received by interviews with staff, and facility documents the above allegation cannot be verified. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED
An exit interview was conducted, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021

LIC9099 (FAS) - (06/04)

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