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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 561701236
Report Date: 08/28/2019
Date Signed: 09/03/2019 07:57:48 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/03/2019 and conducted by Evaluator Jill M Hazelhofer-Laxo
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20190703163543
FACILITY NAME:FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.FACILITY NUMBER:
561701236
ADMINISTRATOR:LEDESMA, MELISSAFACILITY TYPE:
850
ADDRESS:1338 EAST SANTA CLARA STREETTELEPHONE:
(805) 653-5304
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:61CENSUS: 20DATE:
08/28/2019
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Elizabeth StrasswykTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility staff comingle children
Facility staff leave children unattended
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jill Laxo and Francisco Pedroza made an unannounced inspection to conclude a complaint investigation. LPA interviewed toured the facility with Director Elizabeth Stasswyk. There were 20 children with two staff members.

Investigation included two unannounced inspections by LPA on 07/12/2019 and 08/28/2019. Regarding the above allegations LPA reviewed children's and staff files, toured the facility, and interviewed staff members. Based on interviews, observation and record review conducted by LPA, the preponderance of evidence standards have been met, therefore, the above allegations are SUBSTANTIATED. Today, deficiencies cited under Title 22 Division 12. Appeal rights given.

Notice of site visit posted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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 17-CC-20190703163543
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.
FACILITY NUMBER: 561701236
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2019
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.
This requirerment has not been met as evidenced by:
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Director stated notice will be given to all staff outlining the staff requirements which state licensee will stay in compliance and maintain supervision of children in care. Director will provide the staff signed memo by email to LPA Laxo by 09/06/2019.
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Based on LPA interviews the licensee failed to meet the requirement of supervising children in care.
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Type B
09/06/2019
Section Cited
CCR
101161(a)
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101161 Limitations on Capacity and Ambulatory Status:
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement has not been met as evidenced by:
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Director stated notice will be given to all staff outlining the license conditions of limitations and will have all staff sign notification. Director will provide the staff signed notification to LPA Laxo by email by 09/06/2019.
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Based on LPA interviews the licensee failed to meet the requirement of conditions of limitations specified on the license..
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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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2