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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360904126
Report Date: 06/24/2025
Date Signed: 06/24/2025 04:03:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/23/2025 and conducted by Evaluator Raymond Moorehead
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20250423112100
FACILITY NAME:FAITH LUTHERAN DAY CARE CENTERFACILITY NUMBER:
360904126
ADMINISTRATOR:JOY KIRBYFACILITY TYPE:
850
ADDRESS:12449 CALIFORNIA STREETTELEPHONE:
(909) 790-1816
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:30CENSUS: 19DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Denise Simpson, Interim DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Reporting Requirements/Staff are not reporting serious incidents to authorized representatives (Admission Agreement)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to conclude a complaint investigation which was initiated on 04/30/2025 with Director Joy Kirby. LPA met with Interim Director Denise Simpson, toured the facility, took census, and discussed the following.

During the investigation, LPA made observations, reviewed pertinent documentation, and conducted interviews with pertinent individuals.

It was alleged that staff are not reporting serious incidents to authorized representatives.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
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 09-CC-20250423112100
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FAITH LUTHERAN DAY CARE CENTER
FACILITY NUMBER: 360904126
VISIT DATE: 06/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation of staff not reporting serious incidents to authorized representatives, it was reported that a incident took place regarding a child/teacher and that it was not reported to the child's authorized representatives. A pertinent staff interview acknowledged and identified this incident. The pertinent staff interview stated that there was a parent/authorized representative at the facility that reported that they saw a teacher handling a child in a rough manner. Further, the facility conducted their own internal investigation and did not find substantial evidence to show that the reported incident took place. Therefore, it was stated that the facility did not report the reported incident to the child's authorized representatives because they were not able to confirm that the allegation happened. This was deemed to be in which is in violation of Title 22 Regulation Reporting Requirements: 101212 (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

LPA conducted a consult with Interim Director Denise Simpson and informed the facility that all allegations made are required to be reported to the Department and parent/authorized representative, even if it was a unconfirmed allegation.


Based on interviews of pertinent individuals that were conducted, and a review of additional pertinent information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

See LIC 9099-D for cited deficiency.

An exit interview was conducted with Interim Director Denise Simpson, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site Visit (LIC 9213) was issued.

The Notice of Site Visit shall be posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit must remain posted for 30 consecutive days. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20250423112100
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FAITH LUTHERAN DAY CARE CENTER
FACILITY NUMBER: 360904126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2025
Section Cited
CCR
101212(1)(C)
1
2
3
4
5
6
7
Title 22 Regulation 101212 (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility agrees to conduct a staff training, to ensure that each staff member is aware of the Department's Reporting Requirements. Facility agrees to submit staff member sign-in sheets, acknowledging understanding of Reporting Requirements.
8
9
10
11
12
13
14
It was stated that the facility did not report the reported incident because they were not able to confirm that the allegation happened.
8
9
10
11
12
13
14
Facility also agrees to submit an Unusual Incident Report to the Department, including the information of this reported incident.
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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5