566210154-11-1-2023-17-CC-ATOO-CXEVGP-20231109152551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 566210154
Report Date: 11/01/2023
Date Signed: 11/01/2023 12:29:31 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 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
08/09/2023 and conducted by Evaluator Susana Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20230809085816

FACILITY NAME:	PROMISELAND PRESCHOOL CAMARILLO		FACILITY NUMBER:	566210154
ADMINISTRATOR:	TERRI BEAUMONT		FACILITY TYPE:	850
ADDRESS:	380 MOBIL AVE.		TELEPHONE:	(805) 482-5250
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	60	CENSUS: 6	DATE:	11/01/2023
		UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Terri Beaumont		TIME COMPLETED:	12:44 PM

ALLEGATION(S):

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Staff did not provide responsible party with a copy of child's records.

INVESTIGATION FINDINGS:

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On Novemeber 1, 2023 Licensing Program Analysts (LPA's) Susana Martinez and Veronica Diaz conducted an unnannounced inspection to deliver the findings of the above mentioned allegation stating staff did not provide responsible party with a copy of child's records. LPA's met with director Terri Beamount and advised her of the purpose for the inspection. Together with the director LPA's toured the facility. At the time of inspection there were 6 children in the care of 2 adults.

The Department received a complaint alleging staff did not provide responsible party with a copy of child's records. The reporting party (RP) states that child's (C1) other parent signed the child up at this daycare facility without their knowledge. RP reports making several attempts to obtain a copy of the child's facility records with staff however, staff will not expedite RP's request. On 8/9/2023,RP she requested a copy of child's admissions paperwork, a copy of the child's sign in/sign out documentation, and any other documentation pertaining to the child's care at the facility. RP stated that there is a court documentation which shows 50/50 custody of C1.
Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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-20230809085816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PROMISELAND PRESCHOOL CAMARILLO	FACILITY NUMBER: 566210154
	VISIT DATE: 11/01/2023

NARRATIVE

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LPA Martinez conducted staff interviews and record review. Director states there is a custody order in place regarding C1. LPA obtained a copy of the court orders from the facility. The court orders indicate the RP has joint legal custody of the child.

Based on LPAs observations, interviews which were conducted, documents gathered and record review, the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

A type B citation was issued during today's inspection: CCR: 101221 Child's Records(e) A child's records shall also be open to inspection by the child's authorized representative.

LPA's recommended for center to visit childcarelaw.org to review resources regarding contracts between parents and providers.

A notice of site visit was given and should remain posted for 30 days.

Exit interview conducted, appeal rights were given, and report was reviewed with director Terri Beaumont.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 17-CC-20230809085816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PROMISELAND PRESCHOOL CAMARILLO	FACILITY NUMBER: 566210154
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 11/15/2023 Section Cited CCR 101221(e)	1 2 3 4 5 6 7	101221 Child's Records (e) A child's records shall also be open to inspection by the child's authorized representative. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Center is to submit a written statement on how they plan to prevent this deficiency from occurring again by 11/15/23.
	8 9 10 11 12 13 14	Based on observation, interviews conducted, and record review, Center did not comply with the deficiency cited above as center did not provide authorized representative with child's records which poses a potential risk to the health, safety and or personal rights of 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 Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC9099 (FAS) - (06/04)

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