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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376701328
Report Date: 11/20/2020
Date Signed: 11/23/2020 08:32:29 AM



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
08/14/2020 and conducted by Evaluator Casey Gulley
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20200814090825
FACILITY NAME:RISING STAR PRESCHOOLFACILITY NUMBER:
376701328
ADMINISTRATOR:TERRI BERCASIOFACILITY TYPE:
830
ADDRESS:3054 FAIRMOUNT AVENUETELEPHONE:
(619) 213-9356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:18CENSUS: 7DATE:
11/20/2020
UNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Ashley HofmanTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility is operating over ratio
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Casey Gulley, conducted an unannounced complaint tele-inspection, due to the COVID-19 pandemic, for the purpose of delivering findings for the above listed allegation. LPA met with Ashley Hofman and conducted a facility tour. During the investigation, LPA inspected the facility, interviewed licensee, staff, witnesses, and daycare parents. LPA reviewed children’s attendance logs and staff timesheets and work schedules.

Based on record review and staff interviews, it has been determined that on at least one occasion on August 4, 2020, one teacher provided care for five (5) infants for up to 10 minutes.

Based on interviews which were conducted 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, Division 12 and Chapter 1) are being sited on the attached LIC 9099D).

See 9099-C for continuation
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 20-CC-20200814090825
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: RISING STAR PRESCHOOL
FACILITY NUMBER: 376701328
VISIT DATE: 11/20/2020
NARRATIVE
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During today’s visit facility was cited one Type A deficiency, See LIC 9099-D page for cited deficiency. An exit interview was conducted with Ashley Hofman. The following reports were discussed and will be provided to licensee via email: LIC9099, LIC9099-C, LIC9099-D, appeal rights (LIC 9058), Acknowledgment of Receipt of Licensing Reports (LIC9224). LPA informed licensee upon receipt, licensee shall post licensing reports for 30 days and provide copies of current licensing reports to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months. In addition, LIC9224, must be signed by parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility and placed in each child’s record for the next 12 months. LPA informed licensee LIC9213 – Notice of Site Visit shall be posted for 30 days from today’s date. COVID-19 State of emergency read receipt notification will be used in place of licensee’s signature
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 20-CC-20200814090825
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: RISING STAR PRESCHOOL
FACILITY NUMBER: 376701328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2020
Section Cited
CCR
101416.5(b)
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101416.5 Staff-Infant Ratio(b)-There shall be a ratio of one teacher for every four infants in attendance.


This requirement was not met as evidenced by:
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Assistant Director stated that additional staff has been hired. Aisstant Director stated a personnel facilty roster LIC 500 will be submitted by 11/23/20.
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Based on interviews and record reviews, the licensee did not ensure there was a ratio of one teacher observing and supervising no more than 5 children in care, which poses an immediate Health and Safety risk to children in care.
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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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3