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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 421712020
Report Date: 02/09/2022
Date Signed: 02/18/2022 07:54:50 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
11/22/2021 and conducted by Evaluator Francisca Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20211122182825
FACILITY NAME:CAC - SIERRA MADRE CENTERFACILITY NUMBER:
421712020
ADMINISTRATOR:CASSANDRA HARTFACILITY TYPE:
850
ADDRESS:1002 E. SIERRA MADRE AVE.TELEPHONE:
(805) 349-9707
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:50CENSUS: 25DATE:
02/09/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Carla Ayala & Bertha HerediaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Conduct Inimical
INVESTIGATION FINDINGS:
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On 2/9/22, at 10:20 AM, Licensing Program Analyst (LPA) Francisca Velazquez made an unannounced inspection to the abovementioned Child Care Center (CCC) to deliver a finding with regard to an investigation related to Conduct Inimical. Specifically, a Staff member, hereby referred as S1 had been using drugs in the bathroom and overdosed. Drugs were observed on the scene. LPA met with Carla Ayala, the Site Supervisor of CCC, and explained the purpose of the inspection. LPA notes there are twenty-five (25) preschool age children present being cared by four (4) teaching staff and one (1) teaching aide in addition to CCC cook and CCC Family Service Advocate.

Site Supervisor reported that their agency, Community Action Commission (CAC) also known as Communify has concluded their own investigation and has officially terminated S1. Site supervisor stated that all staff members present during the incident are doing well. CAC offered all the staff members present in the CCC during the incident services through their Employment Assistant Program (EAP).
CONT 9099-C

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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-20211122182825
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: CAC - SIERRA MADRE CENTER
FACILITY NUMBER: 421712020
VISIT DATE: 02/09/2022
NARRATIVE
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The investigation included interviews with S1 and all staff member present during the incident, Program Manager and Program Director, Santa Maria Police Department and Santa Maria Fire Department. The statements the LPA obtained from all parties corroborated the allegation. A reasonable interpretation of the statements received from all parties reveal a violation of Conduct Inimical of children in care.

Based on LPAs observation and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12 and 101206(a)(1)(c) and Health and Safety Code 1596.885, is being cited on the attached LIC 9099 D).

A closing interview was conducted with the Site Supervisor, Carla Ayala. Site Supervisor advised of their right to appeal and was provided appeal rights. LPA informed Licensee of the need to provide a plan of correction to CCLD as well as the time which the plan of correction needs to be submitted to CCLD.

The Notice of Site Visit was provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

On 2/9/22 at around 4:00 PM, LPAs laptop went on consistency check. LPA left the facility and explained to site supervisor that LPA will return at a later day to gather signatures for reports written on 2/9/22. LPA returned on 2/17/2021 and met and reviewed reports with Bertha Heredia.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20211122182825
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: CAC - SIERRA MADRE CENTER
FACILITY NUMBER: 421712020
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2022
Section Cited
HSC
1596.885
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Conduct Inimical- 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 reqyuirement was not met as evidenced:
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Agency reported that S1 has been terminated from employment and is no longer assocaited to their faclity. Agency agrees to submit all docuemtns related to CAC internal investigation regarding this incident.
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On 11/22/21, S1 was found overdosed in the restroom of the CCC. Drugs were observed in the scene. This is an immediate risk to the health and safety of children and staff in the facility.
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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: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3