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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573600895
Report Date: 11/03/2020
Date Signed: 11/03/2020 11:25:45 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2020 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200820153029
FACILITY NAME:ST. JOHN'S PRESCHOOL & CHILDCARE CENTERFACILITY NUMBER:
573600895
ADMINISTRATOR:SHILOH BEARDFACILITY TYPE:
850
ADDRESS:434 CLEVELAND STREETTELEPHONE:
(530) 662-0764
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:72CENSUS: DATE:
11/03/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shiloh BeardTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff failed to adhere to the parent hand book policy.
INVESTIGATION FINDINGS:
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A teleinspection was conducted at the facility, due to the recent COVID19 State of Emergency. Licensing Program Analyst (LPA) Chayntel Hunter spoke with Director, Shiloh Beard to deliver the findings of the complaint investigation regarding the above allegation. In lieu of Director's signature, LPA Hunter is emailing the report with a read receipt request.

During the course of the investigation, LPA Hunter conducted interviews, and obtained information pertaining to allegation. It was alleged that staff failed to adhere to the parent handbook policy. LPA received and reviewed the parent handbook and the facility's discipline policy. Through interviews conducted it was revealed that facility staff did not follow all the steps outlined in their discipline policy. Although staff had a meeting with the parent, facility staff did not provide a written two week action plan for C1.

Report continues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
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 5
Control Number 53-CC-20200820153029
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ST. JOHN'S PRESCHOOL & CHILDCARE CENTER
FACILITY NUMBER: 573600895
VISIT DATE: 11/03/2020
NARRATIVE
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Based on the interviews and review of records that revealed facility did not follow steps outlined in their discipline policy, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.

An exit interview was conducted with the Director. Appeal rights were printed and provided. Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2020 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200820153029

FACILITY NAME:ST. JOHN'S PRESCHOOL & CHILDCARE CENTERFACILITY NUMBER:
573600895
ADMINISTRATOR:SHILOH BEARDFACILITY TYPE:
850
ADDRESS:434 CLEVELAND STREETTELEPHONE:
(530) 662-0764
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:72CENSUS: DATE:
11/03/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shiloh BeardTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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2
3
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9
Staff forced day-care child to take a nap.
Staff restrained day care child.
INVESTIGATION FINDINGS:
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A teleinspection was conducted at the facility, due to the recent COVID19 State of Emergency. Licensing Program Analyst (LPA) Chayntel Hunter spoke with Director, Shiloh Beard to deliver the findings of the complaint investigation regarding the above allegation. In lieu of Director's signature, LPA Hunter is emailing the report with a read receipt request.

During the course of the investigation, LPA Hunter conducted interviews, and obtained information pertaining to allegation. It was alleged that staff forced C1 to take a nap. Interviews conducted did not reveal that C1 was forced to take a nap. Interviews revealed that the staff will encourage children to sleep, but if they do not then children are offered a quiet activity. It was also alleged that a staff member restrained C1. Although it was admitted staff were required to redirect C1, interviews conducted revealed that C1 was potentially grabbing objects to throw at other students in care.

Report continues on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20200820153029
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: ST. JOHN'S PRESCHOOL & CHILDCARE CENTER
FACILITY NUMBER: 573600895
VISIT DATE: 11/03/2020
NARRATIVE
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Based on the information obtained throughout the course of this investigation the above allegations could not be substantiated or dismissed. LPA learned that C1 was not forced to nap, but was required to stay on their mat and was provided a quiet activity. LPA also learned that staff had to redirect C1 from throwing objects at other children in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20200820153029
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ST. JOHN'S PRESCHOOL & CHILDCARE CENTER
FACILITY NUMBER: 573600895
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2020
Section Cited
CCR
101219(f)
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Admission Agreements
101219 (f) The licensee shall comply with all terms and conditions set forth in the admission agreement.


This requirement was not met as evidenced by:

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Director stated she would develop a written addendum outlining facility's policy on termination. Director will provide LPA with updated parent handbook via email:

chayntel.hunter@dss.ca.gov

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Based on interviews conducted and record reviews, it was revealed that facility staff did not provide C1 with a written two week action plan. This is a potential health and safety risk to 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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5