<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573619923
Report Date: 05/28/2019
Date Signed: 06/13/2019 11:37:20 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
05/14/2019 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20190514164746
FACILITY NAME:PEREGRINE SCHOOL - SOUTH (PS)FACILITY NUMBER:
573619923
ADMINISTRATOR:HAMMOND, LORIEFACILITY TYPE:
850
ADDRESS:2650 LILLARD DRIVETELEPHONE:
(530) 753-5500
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:90CENSUS: DATE:
05/28/2019
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lorie HammondTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to give children safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her restroom needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christopher Bello met with Director Lorie Hammond to close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed 80 Children with 14 teachers. During the investigation LPA conducted interviews, made observations and obtained documents and photos pertaining to the allegation. Staff and director interviews corroborated the above allegation that children were allowed to use the restroom behind bushes at a park that did not have bathroom facilities available. Staff interviews revealed that on various occasions the children have urinated behind the bushes. Based on LPAs' investigation the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED.
Title 22 deficiencies are cited on the subsequent page of this report. Type Acknowledgement forms are to be signed by current parent of the facility and new parents for the next twelve months. LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit posted which must remain posted for 30 days.
***AMENDED REPORT***
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
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 2
Control Number 53-CC-20190514164746
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: PEREGRINE SCHOOL - SOUTH (PS)
FACILITY NUMBER: 573619923
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2019
Section Cited
HSC
101223(a)(2)
1
2
3
4
5
6
7
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This is not met by evidence: Interviews corrobarated the allegation that children were allowed to use the restroom behind bushes at a park that did not have restroom
1
2
3
4
5
6
7
Director stated that she will speak to her staff and that the facility will only use parks with restrooms available for the children to use.
8
9
10
11
12
13
14
facilities in the area. This is considered a immediate risk to the children in care.


***AMENDED REPORT***
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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2