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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566214398
Report Date: 01/12/2022
Date Signed: 01/12/2022 02:08:44 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
10/21/2021 and conducted by Evaluator Sylvia Mendoza-Ceja
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20211021115726
FACILITY NAME:LITTLE TREE PRESCHOOL, THEFACILITY NUMBER:
566214398
ADMINISTRATOR:LYDIA FEDORAKFACILITY TYPE:
850
ADDRESS:1690 E. MAIN STREETTELEPHONE:
(805) 652-1609
CITY:VENTURASTATE: CAZIP CODE:
93001
CAPACITY:55CENSUS: 54DATE:
01/12/2022
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Lydia FedorakTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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1. Staff inappropriately restrained daycare children while in care
2. Staff did not provide adequate supervision
3. Staff did not properly report incidents involving daycare children
INVESTIGATION FINDINGS:
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On January 12, 2021 at 11:35 AM., Licensing Program Analysts (LPA) S. Mendoza-Ceja conducted an unannounced inspection in order to conclude the complaint which was initiated on 10/25/2021. The investigation was conducted by LPA Patterson which included interviewing the Director, complainants, and staff.
Allegation 1: LPA interviewed staff. Staff interviews S1, S2, S4, and S6 all stated that children were restrained in a highchair when displaying challenging behaviors. Both S1 and S2 stated that they had personally restrained a child in a highchair. This was later reinforced by emails from S1 and S2 explaining that they were the individuals utilizing a highchair to restrain children.
Allegation 2 and 3: LPA interviewed staff. Staff S1, S4, S5, S6, and S7 all stated that a child was left alone outside in the sandbox while children and staff transitioned inside. Staff S1 and S7 stated that there was a child who injured their head while in care but neither individual witnessed the event. Neither unusual incident was reported to CCLD.

Director Lyida Fedorak stated children are adequately supervised and disagrees children are inappropriately restrained and will be filing an Appeal with the Department.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
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 5
Control Number 17-CC-20211021115726
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: LITTLE TREE PRESCHOOL, THE
FACILITY NUMBER: 566214398
VISIT DATE: 01/12/2022
NARRATIVE
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Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s), staff inappropriately restrained daycare children while in care, staff did not properly report incidents involving daycare children, and staff did not provide adequate supervision
are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.


An exit interview was conducted, and Plan of Correction was reviewed and developed with the Director. A copy of this report and appeal rights were discussed and left with the Director.


Upon receipt, post and provide copies of this licensing report: to parents/guardians of children in care at the facility and to parents/guardian of children newly enrolled at the facility during the next 12 months. Licensee shall obtain signatures of parents/guardian on the Acknowledgement of Receipt of Licensing Reports LIC 9224
LPA observed the Notice of Site Visit posted.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 17-CC-20211021115726
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: LITTLE TREE PRESCHOOL, THE
FACILITY NUMBER: 566214398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2022
Section Cited
CCR
101223(a)(3)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...
This violation was evidenced by:
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Correct Immediately.
Submit a written plan to ensure this violation is not repeated.
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Based on interviews and record review which revealed a high chair was used in order to restrain a child with challenging behaviors.

This poses an immediate risk to the Health and Safety of childrenin care.
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Type A
01/13/2022
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation
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Correct Immediately.
Submit a written plan to ensure this violation is not repeated.
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This violation was evidenced by:
Based on interviews and record review which revealed a child was left alone outside in the sandbox while children and staff transitioned inside. In addition, there was a child who injured their head while in care but neither individual witnessed the event. Neither unusual incident was reported to CCLD. This poses an immediate risk to the Health and Safety of children 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 17-CC-20211021115726
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: LITTLE TREE PRESCHOOL, THE
FACILITY NUMBER: 566214398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2022
Section Cited
CCR
101212(d)
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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This violation was evidenced by:
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Correct Immediately.
Please submit a written plan to Licensing for review by 01/13/2021.
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Based on interviews and record review which revealed Director did not report the incidents in a timely manner which occurred in June - October 2021.
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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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5