566210212-10-12-2022-17-CC-ATOO-CK6RLC-20221013130652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 566210212
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:57:13 PM

Substantiated

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
07/07/2022 and conducted by Evaluator Rona Chavez

COMPLAINT CONTROL NUMBER: 17-CC-20220707124624

FACILITY NAME:	HOLY CROSS PRESCHOOL		FACILITY NUMBER:	566210212
ADMINISTRATOR:	SAMANTHA CROCE		FACILITY TYPE:	830
ADDRESS:	1212 MARICOPA HWY		TELEPHONE:	(805) 646-8121
CITY:	OJAI	STATE: CA	ZIP CODE:	93023
CAPACITY:	20	CENSUS: 9	DATE:	10/12/2022
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Marisa Gruber		TIME COMPLETED:	11:48 AM

ALLEGATION(S):

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Reporting Requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rona Chavez made an unannounced visit to conclude a complaint investigation. LPA met with Assistant Director Marisa Gruber and together toured the facility inside and out. During the inspection there were nine (9) infants in Care and 3 teachers providing supervision.

Allegation stated reporting requirements were not being followed. The investigation included two (2) unannounced inspections, interviews with parents, Director, staff and document review.
Over the course of interviews, parents reported Unusual Incidents including a child who required medical attention and illness outbreaks. LPA reviewed documented outbreak notification emails sent to parents. Although notifications were provided to parents and authorized representatives, per regulation the center is required to report unusual incidents to Community Care Licensing (CCL). Director Samantha Croce failed to report several of the reviewed Unusual Incidents to CCL.
Cont on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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-20220707124624

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 PRESCHOOL	FACILITY NUMBER: 566210212
	VISIT DATE: 10/12/2022

NARRATIVE

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The allegation regarding reporting requirements is substantiated a Type B deficiency (Title 22 California Code of Regulations 101212 (d)(1)(B)(E)) is being cited on the attached LIC 9099-D.

Assistant Director and LPA discussed POC and will watch training on CCLD website on Reporting Requirements and provide a written statement on understanding the requirements and timelines.

During the Exit interview with Assistant Director Marisa Gruber a copy of the report, appeal rights and Notice of Site Visit was provided.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 17-CC-20220707124624

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 PRESCHOOL	FACILITY NUMBER: 566210212
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/12/2022 Section Cited CCR 101212(d)(1)(B)(E)	1 2 3 4 5 6 7	Reporting Requirements (d)Upon the occurrence, during the operation of the child care center of any of the events specified…(1) Events reported shall include the following: (B) Any injury to any child that requires medical treatment.(E) Epidemic outbreaks This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to review Child Care Reporting Requirements training on CCLD website and submit a written statement regarding understanding of the timelines for Reporting Requirements under Title 22 regulations by 10/26/2022.
	8 9 10 11 12 13 14	Record review, interviews with director, staff and parents confirmed epidemic outbreaks and child injury reports occured and direcror failed to report to CCL.	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: Rona Chavez	TELEPHONE: (424) 299-1480
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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