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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045407962
Report Date: 12/17/2021
Date Signed: 12/17/2021 11:15:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2021 and conducted by Evaluator Kirk Marks
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20211210090443
FACILITY NAME:LITTLE PINES PRESCHOOLFACILITY NUMBER:
045407962
ADMINISTRATOR:TELLEZ, SHELLYFACILITY TYPE:
850
ADDRESS:2022 FRANKLIN STREETTELEPHONE:
(530) 965-2202
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:23CENSUS: DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Director, Shelly TellezTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility is not following COVID-19 mask requirements for children.
INVESTIGATION FINDINGS:
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On 12/17/2021 at 10:20, Licensing Program Analysts (LPA) Kirk Marks and Nicolette Cunningham conducted an unannounced complaint inspection and met with director Shelly Tellez. It was alleged that the facility is not following COVID-19 facial covering guidance, specifically that children in care are not wearing facial coverings.

The director was interviewed on 12/17/2021 at 12:25 and stated that the facility’s policy regarding facial coverings for children is that staff will try to encourage children to wear masks when they arrive to the facility. The director has provided verbal policy only with parents and no written policy has been completed. The licensee stated that facility staff will encourage children to wear a mask when they arrive to the facility and masks are available if a child requests one.

(continued on page 2)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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 3
Control Number 13-CC-20211210090443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: LITTLE PINES PRESCHOOL
FACILITY NUMBER: 045407962
VISIT DATE: 12/17/2021
NARRATIVE
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(continued from page 1)

The LPAs toured the facility at 10:30. The LPAs observed no mask signage posted. A supply of masks for children was kept on a shelf near the kitchen. There were a total of five children observed and none of them wearing facial coverings. The children not wearing facial coverings (C1 – C5) were sitting at a table together doing an art project.

The Director stated that there are no children with medical exemptions for mask wearing.

Provider Information Notice (Pin) 21-29-CCP FACE COVERING REQUIREMENTS AND GUIDANCE FOR CHILD CARE PROVIDERS REGARDING CORONAVIRUS DISEASE 2019 (COVID-19) was discussed and a copy was provided during the inspection.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 13-CC-20211210090443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: LITTLE PINES PRESCHOOL
FACILITY NUMBER: 045407962
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2021
Section Cited
CCR
101223(a)(2)
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The director shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director provided masks to all children. LPAs observed staff encouraging children to wear them and observed all children wearing the masks during the inspection. The director stated that staff will continue to encourage children to wear masks at all times.
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This requirement was not be as evidenced by:
Based on observations and interview, the director did not ensure the personal rights of children in care in that five of five children in care (C1 – C5) did not wear face coverings while in the facility, as required by the Order of the State Public Health Officer (June 11, 2021), and an individual face covering exception did not apply. 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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Kirk Marks
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3