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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406211108
Report Date: 01/27/2020
Date Signed: 01/27/2020 06:13:09 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2019 and conducted by Evaluator Gigi Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20191108110701
FACILITY NAME:ATASCADERO CHILDREN'S CENTERFACILITY NUMBER:
406211108
ADMINISTRATOR:HARVEST TORREYFACILITY TYPE:
850
ADDRESS:11850 VIEJO CAMINO BDGS. B & CTELEPHONE:
(805) 461-9195
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:99CENSUS: 62DATE:
01/27/2020
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Harvest Torrey
Maggie Payne		TIME COMPLETED:
01:29 PM
ALLEGATION(S):
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Facility failed to properly report injury to child's authorized representative.
Staff failed to properly observe behavior and health of child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced inspection to deliver the final findings on the above allegations. LPA met with Directors Harvest Torrey and Maggie Payne. There were 58 preschool children, 4 toddlers and 11 teachers present including the directors.

Regarding the allegation facility failed to properly report injury to child's authorized representative, It was reported the C1 told parent that C1 fell while on the slide which measures 2.79 feet on 11/07/2019. Child sustained nursemaid's elbow. T1 denied that C1 fell from the slide. On 11/13/19, LPA interview with T1 revealed that T1 was watching C1 and the rest of the children while playing outside. C1 told T1 that C1 fell in the grass area of the playground. T1 stated C1 was complaining about the ankle, T1 checked C1's ankle and knees for cuts or bruises but did not find any. T1 stated that T1 did not witness C1 fell in the grass because T1 was attending to another child in the sand box when C1 was playing in the grass and fell. On 1/21/2020, 2:48 PM LPA interview with C1 revealed that C1 fell in the grass and hurt the ankle. LPA asked C1 to point the ankle, C1 pointed to C1's arm.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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 5
Control Number 17-CC-20191108110701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ATASCADERO CHILDREN'S CENTER
FACILITY NUMBER: 406211108
VISIT DATE: 01/27/2020
NARRATIVE
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LPA interview with Teacher # 2 (T2) revealed that on 11/7/2019 around 10:30 AM, Child # 1 (C1) refused to hand C1's left hand to T2 during an art project because it was hurting. An Accident Report provided to C1's parent on 11/8/2019, a day after the accident stated that the incident occurred at 10:50 AM, 11/07/2019. Despite teachers' knowledge, T2 reported to Director C1's difficulty with the left arm on or around 3:00 PM because T2 attributed the pain to C1's dry skin on the arm. Also, interview with Teacher #1 (T1) also revealed that T1 and T2 were alarmed only when C1's arm was observed to be hanging after nap time and C1 was not using it when C1 was eating snack. Director verbally reported the incident to the parent when parent picked up C1 around 3:30 PM on the same day.

Regarding the allegation staff failed to properly observe behavior and health of a child.
Teacher # 1(T1) checked on C1’s ankle and did not find any bruising or scratch. Teacher # 2 (T2) stated that C1 sat on T2's lap for about 30 minutes and continued to sit on another Teacher’s (T1) lap until 11:30 am. T2 stated that T2 comforted Child # 1 because C1 was a bit emotional and stayed quiet. C1 was whimpering while sitting on T2’s lap. Teachers regarded C1’s behavior being part of adjustment period considering C1 has only been attending the program for 4 days.

Based on LPA’s observation, interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found SUBSTANTIATED. California Code of Regulations, 101226 (a) Health-Related Services is being cited on the attached LIC 9099D

Appeal Rights Given.

LPA observed Director posted the Notice of Site Visit.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 17-CC-20191108110701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ATASCADERO CHILDREN'S CENTER
FACILITY NUMBER: 406211108
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2020
Section Cited
CCR
101226(a)
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The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.
This requirement is not met as evidenced by:
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Director will submit plan of correction no later than 2/3/2020. POC should entail how to ensure that incident and written incident report are promptly reported and provided to parents of day care children.
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Based on LPA review of accident report, incident ocurred on 11/7/2019, 10:50 AM, however, Incident Report was given to C1's parent on 11/08/2019. This poses a potential risk to health and safety of 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2019 and conducted by Evaluator Gigi Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20191108110701

FACILITY NAME:ATASCADERO CHILDREN'S CENTERFACILITY NUMBER:
406211108
ADMINISTRATOR:HARVEST TORREYFACILITY TYPE:
850
ADDRESS:11850 VIEJO CAMINO BDGS. B & CTELEPHONE:
(805) 461-9195
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:99CENSUS: DATE:
01/27/2020
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Harvest Torrey
Maggie Payne		TIME COMPLETED:
01:29 PM
ALLEGATION(S):
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Child sustained injury while in care
INVESTIGATION FINDINGS:
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Regarding the allegation Child sustained injury while in care, LPA conducted investigation regarding allegation that child sustained injury while in care and interviewed teachers (Teacher #1 and Teacher #2), Director, parents and Child #1 (C1 confidential list). C1 informed T1, that C1 fell on the grass and hurt C#1’s ankle. On 11/13/2019, LPA interviewed T1 and stated that T1 was watching C1 and the rest of the children playing outside. T1 denied that C1 fell from the slide. C1 told T1 that C1 fell on the grass area of the playground. T1 stated C1 was complaining about the ankle, T1 checked C1’s ankle and knees for cuts or bruises but did not find anything. T1 did not witness C1 fell because T1 was attending to another child in the sand box at that time C1 was playing in the grass and fell. On 1/21/2020 at 2:48 pm, LPA interviewed Child #1, and found that C1 fell on the grass and hurt the ankle. C1 refers to ankle as C1’s arm.


Continued on 9099 C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 17-CC-20191108110701
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ATASCADERO CHILDREN'S CENTER
FACILITY NUMBER: 406211108
VISIT DATE: 01/27/2020
NARRATIVE
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LPA record review revealed that there was a ratio of 1 teacher to 6 children during the time of the incident. LPA interview with parents of currently and previously enrolled day care children, parents did not corroborate with the allegation. Parents have no concern regarding care and supervision the center is providing their children. Based on the information gathered during the course of the investigation the allegation is deemed unsubstantiated at this time.

Appeal Rights Given.

LPA observed Director posted the Notice of Site Visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5