410500494-9-15-2021-05-CC-GLEG-C7U2BG-20211015171507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 410500494
Report Date: 09/14/2021
Date Signed: 09/15/2021 02:49:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2021 and conducted by Evaluator April Cowan

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210909123919

FACILITY NAME:	PACIFICA PLAYSCHOOL		FACILITY NUMBER:	410500494
ADMINISTRATOR:	WHEELER, SUZANNE		FACILITY TYPE:	850
ADDRESS:	630 HICKEY BLVD		TELEPHONE:	(650) 359-5673
CITY:	PACIFICA	STATE: CA	ZIP CODE:	94044
CAPACITY:	44	CENSUS: 35	DATE:	09/14/2021
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Suzanne Wheeler		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff not enforcing mask mandate at facility

INVESTIGATION FINDINGS:

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On September 14, 2021 at 3:15 PM, Licensing Program Analyst (LPA) Cowan conducted an initial complaint inspection. LPA met with site director and the purpose of the inspection was explained.

During today's inspection, LPA toured facility and interviewed director and 1 staff. Through interviewing director, LPA found that children ages 2 and above are not required nor encouraged to wear masks inside of the facility. Director states that she is concerned that masks may become dirty by ending up on the floor or sand box. Licensee states that she continually runs air purifiers in both classrooms, leaves the windows open for ventilation, and runs the fans to help protect against Covid-19 in the facility.

Based on LPA’s observation and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is founded to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

This report is emailed to site director with a request for reply showing proof of receipt.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

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 05-CC-20210909123919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PACIFICA PLAYSCHOOL	FACILITY NUMBER: 410500494
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/20/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223(a)(2) Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director agree to send notification to parents requiring and encouraging masks wearing for children 2 and above. Director agrees to send LPA a copy of notification sent to parents by 9/20/21.
	8 9 10 11 12 13 14	Based on the interview with director, on 9-14-21, site director 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 facility staff Suzanne Wheeler did not require face coverings in the facility, as required by the CA Department of Public Health Guidance on the Use of Face Coverings issued July 28, 2021, and an individual mask exception did not apply. This is a potential risk to 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: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April Cowan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

LIC9099 (FAS) - (06/04)

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