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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503808081
Report Date: 06/22/2021
Date Signed: 06/22/2021 01:36:22 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2021 and conducted by Evaluator Stefanie Galvan
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210615102031
FACILITY NAME:GRACE LUTHERAN SCHOOL - EXTENDED SCHOOL CAREFACILITY NUMBER:
503808081
ADMINISTRATOR:VIGARS, JEFFFACILITY TYPE:
840
ADDRESS:617 W. ORANGEBURG AVENUETELEPHONE:
(209) 529-1800
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:50CENSUS: 28DATE:
06/22/2021
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Cindy StelleTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not wear face coverings while children were in care
INVESTIGATION FINDINGS:
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On 6/22/21, Licensing Program Analyst’s (LPAs) Stefanie Galvan and Caroline Harris conducted an unannounced complaint inspection to open the above allegation. LPAs met with Director Cindy Stelle and Pastor Thomas Albertson, explained the allegation, toured the facility and census was taken. LPA's observed 28 daycare children present. A complete file review was completed prior to todays visit. LPAs interviewed the Director, Cindy Stelle and Pastor, Thomas Albertson and a copy of the roster was received. The purpose of today's visit was to open the above complaint investigation. The investigation revealed the following:

Upon arrival LPA's observed that children in care were not wearing masks and that staff masks were not being used properly. Based upon interviews conducted with the Director and Pastor, it is revealed that this facility is not requiring mask wearing and instead using a "honor system" for parents entering the facility or "parent preference" regarding children wearing masks. Based upon observations and information gathered during interviews, the preponderance of the evidence standard has been met, therefore the above allegation is found to be substantiated.

California Code of Regulations; Title 22, Division 12, Chapter 1, are being cited on the attached LIC9099D.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie GalvanTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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 04-CC-20210615102031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: GRACE LUTHERAN SCHOOL - EXTENDED SCHOOL CARE
FACILITY NUMBER: 503808081
VISIT DATE: 06/22/2021
NARRATIVE
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An exit interview was conducted with the Director, Cindy Stelle and Pastor Thomas Albertson. A copy of this report and appeal rights were provided to Cindy Stelle. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie GalvanTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 04-CC-20210615102031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GRACE LUTHERAN SCHOOL - EXTENDED SCHOOL CARE
FACILITY NUMBER: 503808081
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by LPA's observations and interviews further discussed on 9099 report.
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Director agrees to be present for Community Care Licensing local licensing call that is scheduled for 6/23/2021. Director states that she is registered for this call which will review the most current guidelines on mask-wearing relating to child care facilities.
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This is a possible risk to the health, safety or personal rights of children in care.
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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: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie GalvanTELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3