493008637-12-2-2020-01-CC-AHON-BX3T8J-20210108133023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493008637
Report Date: 12/02/2020
Date Signed: 12/02/2020 10:44:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2020 and conducted by Evaluator Jennifer Velasco

COMPLAINT CONTROL NUMBER: 01-CC-20200821093038

FACILITY NAME:	ACORN PRESCHOOL, OAK GROVE UNION SCHOOL DISTRICT		FACILITY NUMBER:	493008637
ADMINISTRATOR:	ROBISON, REBECCA		FACILITY TYPE:	850
ADDRESS:	8760 BOWER STREET		TELEPHONE:	(707) 823-4930
CITY:	SEBASTOPOL	STATE: CA	ZIP CODE:	95472
CAPACITY:	30	CENSUS: 10	DATE:	12/02/2020
		ANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Rebecca Robison		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting in day care child wandering away from facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Due to COVID-19 public health emergency, an announced tele-visit was conducted with director Rebecca Robison (D1) by Licensing Program Analyst Velasco (LPA) to deliver complaint investigation findings. It was alleged a lack of supervision resulted in a child (C1) leaving the facility; specifically, that C1 left the facility when not visually supervised by staff. LPA reviewed facility documents and interviewed three adults (A1, A4, D1) on 08/24/2020 and two adults (A2, S1) on 08/25/2020. Witness statements corroborated the allegation that C1 was not visually supervised while on the playground and was therefore able to abscond from the facility briefly. Based on interviews and facility documents, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. This report was reviewed and discussed with D1. D1’s original signature was not recorded on this report; however, D1 was provided with a copy of the LIC9099 Complaint Investigation Report (CIR) and Appeal Rights in an email dated 12/02/2020, and confirmation of read receipt of the CIR is on file. The following violation of the California Code of Regulation, Title 22, was cited: See attached LIC9099-D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

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 2

Control Number 01-CC-20200821093038

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: ACORN PRESCHOOL, OAK GROVE UNION SCHOOL DISTRICT	FACILITY NUMBER: 493008637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/18/2020 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision. 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. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	D1 stated they will provide training to staff on the need for constant visual supervision of all children, including on the playground. D1 stated they will email training materials and staff signatures as documentation of training to LPA on or before 12/18/2020.
	8 9 10 11 12 13 14	Witness statements corroborate the allegation that staff did not visually supervise C1 on the playground, thereby allowing C1 to abscond briefly from the facility. This posed a potential health and safety risk to children in care.	8 9 10 11 12 13 14	LPA's email address: jennifer.velasco@dss.ca.gov
	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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer Velasco	TELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 2