434416687-8-19-2021-07-CC-ASTR-C85BCE-20211025005722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416687
Report Date: 08/19/2021
Date Signed: 08/19/2021 04:32:36 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
08/13/2021 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210813100317

FACILITY NAME:	HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL		FACILITY NUMBER:	434416687
ADMINISTRATOR:	JESSICA WATTS		FACILITY TYPE:	850
ADDRESS:	8455 WREN AVENUE		TELEPHONE:	(408) 413-2111
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	65	CENSUS: 27	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jessica Watts		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Facility failed to report COVID positive to Licensing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced initial 10 day complaint investigation for the above allegation. LPA met with Site Director Jessica Watts and explained the reason for the inspection.

During today's inspection, LPA interviewed Site Director about reporting protocols. She stated that she is responsible for reporting any usual incidents to Licensing. She informed LPA that she had two cases of COVID. She reported one on 07/29/2021, but did not report the other case to Licensing. LPA obtained a copy of email Site Director sent to LPA Macias to report the case. LPA obtained information in regards to the second case and a copy of

----------------------CONTINUES ON 809 DATED 08/19/2021 PAGE 2-------------------------------

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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 07-CC-20210813100317

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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL	FACILITY NUMBER: 434416687
	VISIT DATE: 08/19/2021

NARRATIVE

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-------------------CONTINUATION OF 9099 DATED 08/19/2021 PAGE 1--------------------------

the LIC 624 during today's inspection. Site Director understands that whenever she has a positive case that she needs to report it to Licensing and submit the LIC 624: Usual Incident Report to Licensing within 7 days. Based on the information obtained during today's inspection, the allegation listed on 9099 dated 08/19/2021 page 1 is found to SUBSTANTIATED, meaning the “preponderance of the evidence” standard has been met.

As a result of this investigation, a Type B citation has been cited. An exit interview was conducted where this report, citation, and plan of correction were discussed and provided to Director Jessica Watts. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 07-CC-20210813100317

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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL	FACILITY NUMBER: 434416687
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/19/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/26/2021 Section Cited CCR 101212(d)	1 2 3 4 5 6 7	Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours... This requirement was not met as evident by:	1 2 3 4 5 6 7	Deficiency was correct during inspection. LPA obtained information of the additional positive case and the LIC 624.
	8 9 10 11 12 13 14	Based on interview, Site Director Jessica stated that she did not report one of the cases of COVID to Licensing within the next working day. This poses a potential risk to the health and safety to the children in care.	8 9 10 11 12 13 14
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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: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

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