430702544-8-29-2019-07-CC-SKNT-BGHNUF-20190930104613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430702544
Report Date: 08/29/2019
Date Signed: 08/29/2019 04:32:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2019 and conducted by Evaluator Shannel Reed

COMPLAINT CONTROL NUMBER: 07-CC-20190725145807

FACILITY NAME:	WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAM		FACILITY NUMBER:	430702544
ADMINISTRATOR:	LYLA SNYDER		FACILITY TYPE:	840
ADDRESS:	1425 LINCOLN AVE		TELEPHONE:	(408) 287-6999
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	200	CENSUS: 171	DATE:	08/29/2019
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Bobbi Urbano		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Lack of supervision resulting in inappropriate interactions between children in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shannel Reed arrived at the facility today to conduct an unannounced complaint investigation to follow up on additional information and deliver investigation findings regarding the allegation that there was lack of supervision resulting in inappropriate interactions between children in care while at an offsite activity at an Aquatics Center. LPA met with the Director, Bobbi Urbano and informed her of the purpose of today’s inspection. LPA interviewed Ms. Urbano and reviewed the complaint allegation with her. Based on the written statements from the teaching staff and Director regarding the incident and their conversations with the staff at the pool and the children involved, as well as follow up interviews with Director Urbano and additional interviews, the information obtained supports the finding that there was inappropriate contact between children in care during a field trip activity. There was a member of the teaching staff present in the bathroom, which is separate from the locker room, where the children where located and changing. No teaching staff witnessed the contact to make appropriate effort to prevent it. Therefore, it is concluded that the preponderance of evidence standard has been met and the above allegations are found to be SUBSTANTIATED. A Type B deficiency is being cited on the attached LIC 9099-D. An exit review was conducted with Ms. Urbino.
NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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 07-CC-20190725145807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAM	FACILITY NUMBER: 430702544
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/29/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/27/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	The Director shall develop and submit plan of correction that ensures that children are visually supervised at all times, including during field trips. The Director shall develop and submit plan to ensure that the teaching staff discuss with the children in care to ensure that they are aware of where and what is appropriate touching and what is not.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: There was inappropriate interactions between children in care during a field trip activity. There was a member of the teaching staff present in the bathroom, which is separate from the locker room where the children where located and changing. No teaching staff witnessed the contact to make appropriate effort to prevent it. The Licensee understands this is a potential risk to the children in care.	8 9 10 11 12 13 14	This plan will be submitted by the POC due date of September 27, 2019.
	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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC9099 (FAS) - (06/04)

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