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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 02/08/2019
Date Signed: 08/07/2019 11:05:14 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOLFACILITY NUMBER:
426213750
ADMINISTRATOR:TERESE MUNOZ-HILLFACILITY TYPE:
850
ADDRESS:219 W. OLIVE AVENUETELEPHONE:
(805) 736-6210
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 37DATE:
02/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Terese Munoz-HillTIME COMPLETED:
05:30 PM
NARRATIVE
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 REPORT AMENDED
A case management visit was conducted by LPA S. Mendoza-Ceja who met with Terese Munoz-Hill regarding an incident that occurred on January 29, 2019. The incident was reported to the Department as required.

On January 29, 2019, at approximately 3:05 during transition time from nap time to the playground day care child #1 was left unattended in the Pre-K 1 classroom for 5 - 7 minutes. It was found that parent #1 observed child#1 crying unattended in the Pre - K 1 classroom looking for his socks. Parent #1 informed staff #1 and #2 who were on the playground with the other children. Staff #1 immediately went to get child #1. When leaving the playground parent #2 also stated she observed child #1 unattended in the classroom.

Staff #1 stated she asked the children to line up to go outside. Staff #1 stated child #1 wanted assistance tying his shoes. Staff #1 stated she told child #1 she would assist him with his shoes outside. Child #1 remained in the Pre-K 1 classroom.

Today, LPA interviewed staff #1, staff #2, and the Director in regards to the incident. LPA reviewed the incident report, staff qualifications, staff #1's file, child #1's file, and the sign in/out sheets. Director stated she informed parent of child #1 of the incident. LPA was advised, staff #1 was supervising of 11 children. Director stated she provided training to staff on February 6, 2019 in regards to Supervision.

An immediate civil penalty is assessed for 500.00 for the lack of Responsibility for Providing Care and Supervision when a child was left unattended in the Pre-k classroom for 5 - 7 minutes. In addition, a previous licensing report was issued on 8/28/2018, giving notice of the same violation. The center was cited for repeating the same violation within 12 months, the following civil penalty of $250.00 shall be assessed until the violation is corrected and a penalty will continue to accrue until the deficiency is cleared. Total Civil Penalty assessed is $750.00.

Based on interviews with staff, and record review revealed the Licensee failed to be in compliance with CCR, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOL
FACILITY NUMBER: 426213750
VISIT DATE: 02/08/2019
NARRATIVE
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The deficiencies cited under Title 22 Division 12 in regards to the above violations. Appeal rights provided.
Upon receipt, post and provide copies of this licensing report: to parents/guardians of children in care at the facility and to parents/guardian of children newly enrolled at the facility during the next 12 months. Licensee shall obtain signatures of parents/guardian on the Acknowledgement of Receipt of Licensing Reports LIC 9224.

LPA observed the Notice of Site Visit posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOL
FACILITY NUMBER: 426213750
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2019
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility for Providing Care and Supervision: Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). -This requirement was not met as evidenced by record reviews and interviews with staff.
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Please submit a written plan o correction to Licensing for review by 2/08/2019.
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On January 29, 2019, at approximately 3:05 during transition time from nap time to the playground day care child #1 was left unattended in the Pre-K 1 classroom for 5 - 7 minutes. It was found that parent #1 observed child#1 crying unattended in the Pre - K 1 classroom looking for his socks. Parent #2 also observed child #1 unattended. An Immediate $750.00 Civil Penalty Assessed.
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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) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
LIC809 (FAS) - (06/04)
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