566208209-9-29-2021-17-CC-FPEA-C7BU6A-20210929151802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566208209
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:18:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	GRACE BRETHREN PRESCHOOL EAST		FACILITY NUMBER:	566208209
ADMINISTRATOR:	JULIA CHANDLER		FACILITY TYPE:	850
ADDRESS:	2762 AVENIDA SIMI		TELEPHONE:	(805) 582-4270
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	136	CENSUS: 93	DATE:	09/29/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Julia Chandler		TIME COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 29, 2021 at 1:54 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with facility Director Julia Chandler and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There was 93 children in care at the time of the inspection. On August 13, 2021, C1's class was currently outside in the playground at the time. When it was time to line up, C1 did not line up with their class. While outside in the playground another child was dropped off. Staff without updating their count when that child arrived, they accounted for the children they went out to the yard and went back to class. Shortly after the facility was contacted via phone that a child is outside alone. Facility Director immediately responded to the yard. The child was found sitting behind the playground structure watching the facility maintenance staff working. At the time the incident, the facility was extending their perimeter fence. Once they were completed with the fence, the older fence was going to be removed. Director advised that the fence was fully secured preventing the child from exiting. Director estimated the child was alone in the yard between three (3) to five (5) minutes. The Director escorted the child to their class and contacted the child's parents to report the incident. According to the facility staff the child has returned back to the facility since the incident. They have updated their policy and procedures to ensure an incident like this won't happen again. LPA observed where the child was sitting. LPA spoke with Director about staff positioning and staff conducting yard check prior to leaving. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GRACE BRETHREN PRESCHOOL EAST	FACILITY NUMBER: 566208209
	VISIT DATE: 09/29/2021

NARRATIVE

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LPA determined that the incident was true and that a lack of supervision did occur. Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate. The facility acknowledged they are being transparent and ensuring the safety of the children in their care.

The following CCR, Title 22, Division 12 regulation was cited: 101229(a)(1) Responsibility for Providing Care and Supervision.

Director was provided a copy of the regulation and advised of their right to appeal. A copy of their appeal rights was provided.

One type B deficiency was cited during today's inspection.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GRACE BRETHREN PRESCHOOL EAST	FACILITY NUMBER: 566208209
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/08/2021 Section Cited	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ... to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher ... visual observation. This requirement is not met as evidence by:
	8 9 10 11 12 13 14	Staff left a child unsupervised in the playground. This poses as a potential Health and Safety risk to clients / children in care.	8 9 10 11 12 13 14
	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: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

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