406215446-10-4-2021-17-CC-MMUR-C7PSKT-20211011135712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 406215446
Report Date: 09/15/2021
Date Signed: 10/04/2021 11:34:14 AM

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
09/13/2021 and conducted by Evaluator Melissa K Stewart

COMPLAINT CONTROL NUMBER: 17-CC-20210913132104

FACILITY NAME:	ZEMAITIS FAMILY CHILD CARE		FACILITY NUMBER:	406215446
ADMINISTRATOR:	DANIELLE ZEMAITIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 464-2678
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 4	DATE:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	01:33 PM
MET WITH:	Danille Zemaitis		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Provider did not quarantine for COVID.
Provider did not report COVID positives.

INVESTIGATION FINDINGS:

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AMENDED report was approved by Licensing Program Manager (LPM) Maria Mueller on 10/4/2021.
On 9/15/2021 at 1:33pm, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, Danielle Zemaitis. All answers indicated no recent exposure to COVID19. LPA explained the purpose of the inspection was to initiate a complaint investigation. Licensee and Assistant wore face coverings. There were four (4) children (including one infant) napping at time of inspection.

Licensee reported close contacts S1 and C1 tested positive for COVID19 and were quarantined in the family's trailer located on the property. Licensee reported that she contacted public health on 8/30/21 and was informed that as long as S1 was quarantined outside of the home, the day care could remain open. S1 was quarantined from 8/21/21 thru 9/7/2021 and C1 was quarantined 8/24/21-9/4/2021. Licensee closed the family child care home 9/6/2021-9/10/2021. Licensee denied having any symptoms herself and reported that she took at home tests on 9/3, 9/6 and 9/11/2021 with negative results. Licensee stated that C2 was tested on 9/6/2021 and the result was negative. continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
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.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 17-CC-20210913132104

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: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
	VISIT DATE: 09/15/2021

NARRATIVE

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AMENDED report was approved by Licensing Program Manager (LPM) Maria Mueller on 10/4/2021.

Licensee did not call public health for advice when S1 and C1 received positive test results therefore it is unknown what the advice regarding closure of the Family Child Care Home or continued quarantine dates for family members may have been.

Licensee did not contact the Community Care Licensing (CCL) office to report that a close contact had been self isolating and/or tested positive for COVID19. Licensee did not notify public health or CCL when she received notification on 9/7/2021 from a parent of a child in care who had tested positive for COVID 19. Licensee stated that she was not aware of the need to notify CCL.

On 9/13/2021, Licensee contacted CCL to report that seven (7) children in care in addition to S1 and C1 had tested positive for COVID19 between the dates of 8/29/21 and 9/8/2021.

Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email. LPA provided PIN 20-11-CCP dated 5/21/2020 which states the following on page 7: "If a facility has been impacted by an individual who has been exposed or tested positive for COVID-19, please adhere to CDPH’s guidelines and contact your local county public health department, report the incident to your local regional office, and communicate with your families about it."

Based on LPAs observations, interviews which were conducted, documents gathered and/or record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

LPA advised Licensee California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. COVID19 Information for San Luis Obispo County can be found atwww.emergencyslo.org/en/covid19.aspx.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Danielle Zemaitis, whose signature on this form confirm receipt of these documents.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
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

LIC9099 (FAS) - (06/04)

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Control Number 17-CC-20210913132104

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: ZEMAITIS FAMILY CHILD CARE	FACILITY NUMBER: 406215446
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/15/2021 Section Cited CCR 102416.2(c)(3)	1 2 3 4 5 6 7	(c) In addition to the events specified in Health and Safety Code Sections 1597.467..., the licensee shall report the following events to the Department: (3) A communicable disease outbreak when determined by the local health authority. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated that she will submit a written plan of correction regarding new policies and or procedures in place to ensure that reporting to CCL/public health is conducted in a timely manner. Licensee will submit the plan to LPA Stewart via email or mail on or before 9/30/21.
	8 9 10 11 12 13 14	Based on interviews conducted, Licensee did not report to CCL or the public health department as required per PIN 20-11-CCP dated 5/21/2020 or CCR102416.2(c)(3) which poses a potential risk to the health and or 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: Melissa K Stewart	TELEPHONE: (805) 689-6267
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

LIC9099 (FAS) - (06/04)

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