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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566208209
Report Date: 12/07/2021
Date Signed: 12/07/2021 01:49:56 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 EASTFACILITY NUMBER:
566208209
ADMINISTRATOR:JULIA CHANDLERFACILITY TYPE:
850
ADDRESS:2762 AVENIDA SIMITELEPHONE:
(805) 582-4270
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:136CENSUS: 87DATE:
12/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Julia ChandlerTIME COMPLETED:
02:05 PM
NARRATIVE
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On December 7, 2021 at 1:00 PM, Licensing Program Analysts (LPAs) Francisco Pedroza and Michael Mathew conducted an unannounced Case Management inspection. LPAs met with facility Director Julia Chandler and advised the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. There were 87 children in care at the time of the inspection.

LPAs were initiating a complaint investigation. During the investigation it was determined an incident occurred on November 29, 2021. The incident involved a parent yelling into a classroom at a teacher with students. Teachers from another classroom heard the commotion and responded to the incident. The Director was contacted and responded to the classroom where the incident occurred. The Director escorted the parent away from the area to diffuse the situation.

On December 7, 2021 at 11:32 AM, LPAs conducted an interview with Director Chandler. Director confirmed that the incident occurred where a parent was yelling at a teacher in the present of children. It was identified that the Director only advised the guardian(s) of one of the children in the classroom. LPAs advised Director that they are required to inform the guardian(s) of all the children when they are involved in an unusual incident. LPAs expressed that the incident could have affected the children in wrong way. Director advised that she understood and informed LPAs that she would have reported the incident, but thought it was not required.

The following CCR, Title 22, Division 12 regulation was cited: 101212(d)(1)(C) Reporting Requirements.

One Type B deficiency was cited today. Director provided Appeal Rights.

NOTICE OF SITE VISIT WAS POSTED
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 12/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2021
Section Cited

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101212 Reporting Requirements
(d) Upon the occurrence, ...Seven days following the occurrence of such event.
(1) Events reported shall include the following:
(C) Any unusual incident ... the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Based on observation, interviews, and records, the licensee did not comply with the section cited above by reporting an incident where parent was yelling at a teacher in the presence of children which poses/posed a potential health, safety or personal rights risk to persons 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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2021
LIC809 (FAS) - (06/04)
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