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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566215214
Report Date: 02/25/2020
Date Signed: 02/25/2020 04:28:04 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
02/05/2020 and conducted by Evaluator Francisco Pedroza
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20200205145858
FACILITY NAME:PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)FACILITY NUMBER:
566215214
ADMINISTRATOR:VICTORIA DE LEONFACILITY TYPE:
830
ADDRESS:4974 COCHRAN AVE.TELEPHONE:
(805) 527-7764
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:20CENSUS: 8DATE:
02/25/2020
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Victoria De LeonTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Personal Rights - Staff utilized physical forms of discipline on children in care
Record Keeping - Facility failed to notify CCL and Parents of inappropriate discipline
INVESTIGATION FINDINGS:
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On February 25, 2020 at approximately 2:30 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced inspection to conclude a complaint investigation. LPA met with Director Victoria De Leon and advised her the purpose of the inspection. LPA and Director together toured the facility inside and out. There were eight children in care at the time of the inspection.

Allegation stated a staff utilized physical forms of discipline on children in care and the facility failed to notify Community Care Licensing (CCL) and parents. LPA made two unannounced inspections and toured the facility on each visit. During the course of the investigation, LPA conducted interviews, reviewed staff files, and children files. Interviews with staff and the facility Director confirmed knowledge of incidents that occurred which led to S1 being counseled. LPA reviewed S1's file and observed they were counseled for the incidents on March 4, 2019 . S1's last day of employment was March 7, 2019. The facility failed to notify licensing about the events that occurred.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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 4
Control Number 17-CC-20200205145858
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: PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)
FACILITY NUMBER: 566215214
VISIT DATE: 02/25/2020
NARRATIVE
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Based on LPA observations, interviews, and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

A closing interview was conducted with Director. Director was provided and advised of their right to appeal. LPA explained the facility's required plan of correction. Director provided the Acknowledgement of Receipt (LIC 9224). Parents shall receive a copy of 9099, 9099C, and 9099D's. Each parent/guardian shall sign and complete an LIC 9224 with copies maintained in each child's file. Every parent enrolling a new child in the infant program shall receive a copy of the report and sign a LIC 9224 for the next twelve months. Director's signature at the bottom of this report acknowledges they received the reports and understand their rights.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20200205145858
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: PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)
FACILITY NUMBER: 566215214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2020
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, ... clothing, medication or aids to physical functioning.

This requirement is not met evidence by:
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Director advised they will be scheduled for an informal conferece at a later date. Prior to the informal conference, the director will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations and avoid any personal rights violations regarding infants being physically diciplined
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Based on LPA's observations, interviews, and records. A teacher violated children's personal rights using inappropriate physical discipline while employed at the facility. This poses an immediate Health and Safety risk to persons in care.
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 by 03/06/2020 via fax (805) 685-1820, mail, or email to francisco.pedroza@dss.ca.gov
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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) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 17-CC-20200205145858
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: PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)
FACILITY NUMBER: 566215214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited
CCR
101212(d)(1)(D)
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101212 Reporting Requirements
(d) Upon the occurrence,... shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following:
(D) Any suspected physical or psychological abuse of any child.
This requirement was not met evidence by:
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Director advised they will be scheduled for an informal conferece at a later date. Prior to the informal conference, the director will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations and avoid any personal rights violations regarding infants being physically diciplined
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Based on LPA's observations, interviews, and records. The facility failed to notify CCL of the incidents that occurred where a staff physically disciplined children in care. This poses a potential Health and Safety risk to persons in care.
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 by 03/06/2020 via fax (805) 685-1820, mail, or email to francisco.pedroza@dss.ca.gov
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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) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4