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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401701939
Report Date: 09/15/2021
Date Signed: 09/15/2021 01:33:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PEACE CHRISTIAN PRESCHOOLFACILITY NUMBER:
401701939
ADMINISTRATOR:DORIS ANGELFACILITY TYPE:
850
ADDRESS:244 OAK PARK BLVDTELEPHONE:
(805) 489-9644
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:92CENSUS: DATE:
09/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Doris AngelTIME COMPLETED:
01:45 PM
NARRATIVE
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On 9/15/21, at 12:30 PM, Licensing Program Analysts (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) as a follow up to an Unusual Incident Report (UIR) received by the Department on 9/9/21. Circumstances of the UIR involved a CCC teacher, herein Staff #1, inappropriately handling a child in care, herein Child #1.

The LPA met with Doris Angel, Director of the CCC and explained the purpose of the inspection. The LPA, in the company of Director, toured the interior and exterior of the CCC. LPA observed 37 children on site during the inspection along with 6 teachers.

Upon discussing the UIR with the Director, LPA was informed a parent in care, herein Witness #1, observed Staff #1 inappropriately handle Child #1 in the CCC's classroom. Specifically Staff #1 was observed roughly grabbing and pulling Child #1. The information provided by the Director was in accordance with the information provided in the UIR. Director further informed LPA Staff #1's employment with the CCC ended via dismissal after earning of the incident.

The UIR also notes a similar incident occurred with the noted Staff member and another child three weeks prior (8/19/21). Director informed LPA Director admonished Staff #1's actions and informed Staff #1 further actions would constitute grounds for termination. As noted above the information provided by the Director was in accordance with the information provided in the UIR.

A review of the incident reveals Child #1's Personal Rights were violated when being inappropriately handled by Staff #1. Further, reporting requirements were not met by the CCC, upon initial observing Staff #1 act in an inappropriate fashion.

Pursuant to Title 22 of the California Code of Regulations, the following Type A and Type B deficiencies are cited (refer to LIC 809-D). Upon receipt of this report, Director shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled (CONT. 809-C)

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 401701939
VISIT DATE: 09/15/2021
NARRATIVE
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at the facility during the next 12 months. Director/ CCC to provide LIC 9224 for each child in care, have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D and maintain the signed forms in the facility files. Director was provided with the LIC 9224 form. The Director was provided a copy of their Appeal Rghts (LIC9058) and their signature on this form acknowledges receipt of these rights.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 401701939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2021
Section Cited

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101223(a)(3) Personal Rights
(a)The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...
This requirement was not met as evidenced
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by Child #1 be inappropriately handled by Staff #1 on 9/2/21.
This poses an immediate health, safety risk or personal rights of persons 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEACE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 401701939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited

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101212 Reporting Requirements (a)Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following...(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1)(D) Any suspected physical or
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psychological abuse of any child.
This requirement was not met as evidenced by the Director failing to inform CCLD of a child being inappropraitely handled by Staff #1 on 9819/21
This poses a potential health, safety or personal rights risks to persons 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4