406212578-12-15-2021-17-CC-GMIE-CA8RG3-20211231120004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 406212578
Report Date: 12/15/2021
Date Signed: 12/15/2021 03:58:05 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
12/08/2021 and conducted by Evaluator Gigi Reyes

COMPLAINT CONTROL NUMBER: 17-CC-20211208140339

FACILITY NAME:	NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL		FACILITY NUMBER:	406212578
ADMINISTRATOR:	DINA DALE		FACILITY TYPE:	850
ADDRESS:	6225 ATASCADERO MALL		TELEPHONE:	(805) 602-6648
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	30	CENSUS: 14	DATE:	12/15/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Ashley Madden		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is operating out of ratio.

INVESTIGATION FINDINGS:

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On 12/15/2021 at 2:10 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced inspection to conduct a complaint investigation on the above allegation. LPA met with Teacher Ashley Madden. Prior to inspection, LPA asked pre screening questions related to COVID-19, Ms. Madden's responses indicate there was no COVID- 19 exposure on site. On or about 2:50 PM, Director Dina Dale arrived. LPA explained to Director the purpose of the inspection.

Upon LPA's arrival, LPA observed 14 day care children (confidential name list) being supervised by one Staff (Staff#1). Staff # 1 and Director stated that Staff # 2 left around 2:00 PM due to illness.

Based on LPA's observation and interview with Staff, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

Continued on LIC 9099 C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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 17-CC-20211208140339

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: NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL	FACILITY NUMBER: 406212578
	VISIT DATE: 12/15/2021

NARRATIVE

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A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Director, Dina Dale. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC9099D for documentation of deficiencies cited:

LPA provided copies of UPDATED CORONAVIRUS 2019 (COVID-19) INDUSTRY GUIDANCE FOR CHILD CARE SETTINGS (PIN 20-18-CCP)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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Control Number 17-CC-20211208140339

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: NORTH COUNTY CHRISTIAN SCHOOL - PRESCHOOL	FACILITY NUMBER: 406212578
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/16/2021 Section Cited CCR 101216.3(a)	1 2 3 4 5 6 7	101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	During the time of inspection, the deficiency was corrected, on or about 2:50 PM director arrived. Director agreed to submit a written plan of correction(POC) to ensure the same violation will not be repeated. POC will be submitted no later than 12/16/2021. gigi.reyes@dss.ca.gov
	8 9 10 11 12 13 14	Based on LPA's observation, there were 14 day care children in a room supervised by one teacher. Staff 1 and director stated that Staff 2 left at 2:00 PM due to illness. This poses an immediate risk to health and safety of children in care.	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: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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