406215446-10-4-2021-17-CC-MMUR-C7PSKS-20211011135711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 406215446
Report Date: 10/04/2021
Date Signed: 10/04/2021 11:44:50 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: 10	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Danielle Zemaits		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Provider did not quarantine for COVID.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/4/2021 at 10:56am, 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 provide copies of AMENDED report (original date 9/15/21) and complete the complaint investigation, with additional citation.

PIN 21-18-CCP advised providers of the Child Care Industry Guidance updated on 6/29/21. Licensee did not comply with the guidance noted under the heading, Isolation for Illness which states: If an individual who resides in a family child care home is exhibiting symptoms of COVID-19, the facility should follow public health guidelines for quarantine or isolation.

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

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: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/05/2021 Section Cited HSC 1596.885	1 2 3 4 5 6 7	The Department has the authority to suspend or revoke a license on any of the grounds specified in Health and Safety Code Section 1596.885. Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will immediately adhere to CDPH guidance on Isolation and Quarantine updated 9/9/2021 and Health and Safety Code Section 1596.885. Licensee to submit a written plan to LPA Stewart of the adherence to current CDPH/CDC guidance for child care programs and Health and Safety Code Section 1596.885 no later than 10/5/2021.
	8 9 10 11 12 13 14	On 8/21/21-9/3/21, Licensee did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that in that Licensee, a close contact of an individual with a suspected or confirmed case of COVID19, did not self-quarantine as recommended by the CDPH	8 9 10 11 12 13 14	and the CDC. This posed an immediate risk to the health and/or safety of children in care which resulted in five (5) children and several family members of children in care testing positive COVID19.
	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: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

Page: 3 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: 10/04/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

A copy of PIN 21-18-CCP, California Department of Public Health (CDPH) guidance on Isolation and Quarantine (updated 9/9/2021) and Centers for Disease Control (CDC) COVID19 Child Care Program Symptom Screening Flowchart were provided to Licensee.

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 Zemaits, whose signature on this form confirm receipt of these documents.

Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to Licensee).

LPA provided the Notice of Site visit to be posted for 30 consecutive days.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3