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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340320556
Report Date: 07/18/2023
Date Signed: 07/18/2023 05:52:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2023 and conducted by Evaluator Jennie Tedlos
COMPLAINT CONTROL NUMBER: 53-CC-20230710095839
FACILITY NAME:ST. PETER'S LUTHERAN SCHOOLFACILITY NUMBER:
340320556
ADMINISTRATOR:DORIS DAHLEFACILITY TYPE:
850
ADDRESS:8701 ELK GROVE-FLORIN ROADTELEPHONE:
(916) 689-3050
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:60CENSUS: 9DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Hannah StringerTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision:
Staff left daycare child alone on the playground.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennie Tedlos and Licensing Program Manager (LPM) Bettina Engelman met with Director, Hannah Stringer for the purpose of opening a complaint investigation regarding the above allegation.

The complainant alleged that a daycare child was left alone without staff supervision on the playground. The incident was alleged to have taken place in October 2022. Today, licensing staff observed the care and supervision of children, reviewed records and conducted an interview with Director Stringer. Director explained that there was an incident with a preschool child late last year, in October 2022. The children had just completed outside time and transitioned inside the classroom, with herself and another staff member who was in training. The classroom door shut before Child #1 entered the classroom. Both adults were inside with the class and Child #1 was left on the playground without adult supervision. Director Stringer stated that she was aware that Child #1 was on the playground, and that the child was left without staff supervision for a few seconds, before she went outside to return the child inside.
-- Report continues on subsequent page 9099-C -----

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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 53-CC-20230710095839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST. PETER'S LUTHERAN SCHOOL
FACILITY NUMBER: 340320556
VISIT DATE: 07/18/2023
NARRATIVE
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Based on the interview with the director who described the incident, there is a preponderance of evidence to support the above allegation, where a preschool child was left without staff supervision on the playground. THEREFORE THE ABOVE ALLEGATION IS SUBSTANTIATED.

A Title 22 Type A deficiency was cited today on the subsequent page 9099-D. As a result of the deficiency, Director Stringer understands that LIC 9224 must be signed by all current authorized representatives and potential authorized representatives for up to one year. The LIC 9224 must be kept in each child's file for the Department's review.

An exit interview was conducted, and the report was reviewed with Director Stringer. LPA provided Ms. Stringer with Licensee Appeal Rights. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20230710095839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ST. PETER'S LUTHERAN SCHOOL
FACILITY NUMBER: 340320556
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2023
Section Cited
CCR
101229(a)(1)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director stated there were staff meetings about supervision and transitioning children. Director will send LPA documentation of meeting minutes.
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This requirement was not met as evidenced by LPA learned from Director interview that a child was left on the playground without staff supervision.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4