566215214-2-3-2021-17-CC-GMIE-BXXRGX-20210205120127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 566215214
Report Date: 02/03/2021
Date Signed: 02/03/2021 12:16:39 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
12/28/2020 and conducted by Evaluator Francisco Pedroza

COMPLAINT CONTROL NUMBER: 17-CC-20201228145718

FACILITY NAME:	PHOENIX RANCH SCHOOL & CAMPUS (WEST CAMPUS)		FACILITY NUMBER:	566215214
ADMINISTRATOR:	VICTORIA DE LEON		FACILITY TYPE:	830
ADDRESS:	4974 COCHRAN AVE.		TELEPHONE:	(805) 527-7764
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	20	CENSUS: 6	DATE:	02/03/2021
		UNANNOUNCED	TIME BEGAN:	11:06 AM
MET WITH:	Victoria De Leon		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Physical Plant – Facility roof leaks

INVESTIGATION FINDINGS:

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On February 3, 2021 at 10:05 AM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced tele-visit to conclude a complaint investigation. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA met with facility Director Vicky De Leon and discussed the nature and purpose of the inspection. The tele-inspection was conducted via Zoom. The facility had six infants in care at the time of the inspection.

Allegation stated the facility roof was leaking. LPA made two unannounced tele-visit inspections and toured the facility on each visit. During the course of the investigation, LPA interviewed facility Director and reviewed facility records. Director De Leon confirmed classrooms one and two were leaking during inclement weather. A local business came and repaired the roof for classrooms one and two. Director De Leon advised that the wet ceiling tiles from the leak were replaced as well.

Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

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-20201228145718

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: 02/03/2021

NARRATIVE

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Based on LPAs observations, interviews conducted, and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. No deficiencies cited.

A closing interview was conducted with Director De Leon. A copy of this report was reviewed and provided to Director via email. The delivered receipt confirmation from email will be in lieu of her signature once she received the report. LPA requested a signed copy be provided to Community Care Licensing.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

LIC9099 (FAS) - (06/04)

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