<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 561710698
Report Date: 12/20/2019
Date Signed: 12/20/2019 03:30:34 PM



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
09/26/2019 and conducted by Evaluator Jill M Hazelhofer-Laxo
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20190926125349
FACILITY NAME:HOLY CROSS FAMILY PRE-SCHOOL AND DAY CAREFACILITY NUMBER:
561710698
ADMINISTRATOR:SAMANTHA JULIASFACILITY TYPE:
840
ADDRESS:1212 MARICOPA HIGHWAYTELEPHONE:
(805) 646-8121
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:35CENSUS: 14DATE:
12/20/2019
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Samantha CroceTIME COMPLETED:
03:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child wasn’t accorded privacy while in the restroom.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jill Laxo conducted an unannounced inspection to the above facility to conclude a complaint investigation which was filed on 09/25/2019 and initiated on 10/02/2019. Investigation included two unannounced inspections, obtaining the child care roster, interviewing director, parents of children in care, and other individuals.
Complainant alleged Child wasn’t accorded privacy while in the restroom.
Director Samantha Croce stated on 08/30/2019, while outside, C#1 was in the restroom when C#2 stepped into the bathroom and yelled C#1’s name. Director stated C#1 came out of the bathroom expressing concern that C#2 had seen C#1 on the potty. The bathroom has two stalls, one with a door that locks at the top and one without a door.
Parents and individuals interviewed corroborated concerns regarding the lack of privacy the school age children have when using the bathrooms located near the office.
An exit interview was conducted with director Samantha Croce. A copy of this report was left with director, whose signature on this form confirms receipt of these documents.
Appeal Rights were reviewed and provided. The Notice of Site Visit was posted.
Based on LPA’s observations and interviews, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22 Division 12 Chapter 1) is being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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-20190926125349
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: HOLY CROSS FAMILY PRE-SCHOOL AND DAY CARE
FACILITY NUMBER: 561710698
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited
CCR
101539(b)
1
2
3
4
5
6
7
101539 Fixtures, Furniture, Equipment and Supplies (b) Toilets used by school-age children shall provide individual privacy.



This requirement is not met as evidenced by
1
2
3
4
5
6
7
Director Samantha Croce will submit a written plan to correct the issue of bathroom privacy for the school age program.
8
9
10
11
12
13
14
Based on interviews and observation the licensee failed to ensure the school age children are provided individual privacy when using the bathroom, which poses a potential Health, Safety or Personal Rights risk to the children in care.
8
9
10
11
12
13
14
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: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2