561701236-11-19-2019-17-CC-ATOO-BJ9PPN-20191125102949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 561701236
Report Date: 11/19/2019
Date Signed: 11/19/2019 11:11:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/03/2019 and conducted by Evaluator Jill M Hazelhofer-Laxo

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20190903165051

FACILITY NAME:	FIRST UNITED METHODIST PRESCHOOL & CHILD CARE C.		FACILITY NUMBER:	561701236
ADMINISTRATOR:	ELIZABETH STRASSWYK		FACILITY TYPE:	850
ADDRESS:	1338 EAST SANTA CLARA STREET		TELEPHONE:	(805) 653-5304
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	61	CENSUS: 5	DATE:	11/19/2019
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elizabeth Strasswyk		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Record Keeping-Child was admitted to the toddler option without the permission of the child's authorized representative
Physical Plant-Facility staff is co-mingling children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jill Laxo conducted an unannounced inspection to conclude a complaint investigation. LPA met with Elizabeth Strasswyk and advised the purpose of the inspection. LPA and Director together toured the Toddler Component inside and out. There were five children supervised by one staff at the time of the inspection.

Complaint received alleged "Child was admitted to the toddler option without the permission of the child's authorized representative, and facility staff is co-mingling children.” Investigation included two unannounced inspections, and interviews with complainant, parent, Director and record review.

During the initial complaint inspection 09/05/2019, the referenced allegations were found to need further investigation. Evidence gathered from record review and LPA’s interview with Director and parents determined that the children transitioning from the Infant Program into the Toddler Component did not have written permission from their authorized representatives to participate in the Toddler Component. The Director stated that due to low ratio and staff, children from the Toddler Component were comingled on the playground with the Preschool Program for short periods of time.

Continued on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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 17-CC-20190903165051

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: 11/19/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/27/2019 Section Cited CCR 101216.4(a)(1)	1 2 3 4 5 6 7	101216.4 Preschool Program with Toddler Component: (a) Licensees serving preschool-age...A child who is between 18 months and 36 months of age may participate in the toddler program with written permission from the child's authorized representative. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will provide a written notification requesting written permission for children to transition from the infant program to the toddler component. This notification will be emailed to LPA by 11/27/2019.
	8 9 10 11 12 13 14	Based on interview and record review the licensee failed to obtain written permission from child's authorized representative to transition children from the infant program into the toddler component, which poses a potential Health, Safety or Personal Rights risk to the children in care.	8 9 10 11 12 13 14
Type B 11/27/2019 Section Cited CCR 101216.4(a)(2)	1 2 3 4 5 6 7	101216.4 Preschool Program with Toddler Component: (a) Licensees serving preschool-age children may create a special program component for children who are between 18 months and 36 months...(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children.	1 2 3 4 5 6 7	Licensee will ensure that the Toddler component is conducted in areas physically separate from the Infant and Preschool programs. Licensee will submit a written plan of operation for the Toddler component to LPA Laxo by 11/27/2019.
	8 9 10 11 12 13 14	Based on interview and record review the licensee failed to keep the toddler component separate from the preschool and infant program, which poses a potential Health, Safety or Personal Rights risk to the children in care.	8 9 10 11 12 13 14

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 17-CC-20190903165051

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
	VISIT DATE: 11/19/2019

NARRATIVE

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Based on LPA’s observation, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be Substantiated.

The following CCR, Title 22, Division 12 regulations were cited: 101216.4(a)(1) and 101216.4(a)(2).

Two Type B deficiencies are being cited today based on LPA's observation conducted in accordance with the California Code of Regulations Title 22, See LIC 9099D.

An exit interview was conducted with Director and Plans of Correction were developed. Copies of the appeal rights were provided.

THE NOTICE OF SITE VISIT WAS POSTED.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-Laxo	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC9099 (FAS) - (06/04)

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