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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376105113
Report Date: 03/13/2023
Date Signed: 03/13/2023 10:38:39 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2022 and conducted by Evaluator Adrian L Mangina
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20221117105051
FACILITY NAME:CLAIREMONT CANYONS ACADEMY STATE PRESCHOOLFACILITY NUMBER:
376105113
ADMINISTRATOR:VICTORIA PETERSONFACILITY TYPE:
850
ADDRESS:4133 MT ALBERTINE AVENUETELEPHONE:
(619) 605-1350
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:24CENSUS: 5DATE:
03/13/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Victoria PetersenTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Care and Supervision
Facility failed to report incident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/13/23 at 10:15 AM Licensing Program Analyst (LPA) Adrian Mangina made an unannounced complaint visit for the complaint received on 11/17/22 for the purpose of delivering findings on the above referenced allegations.

It was alleged that a child was injured by another child while in care due to lack of supervision and that the faclity failed to report the incident. Investigator conducted interviews with relevant parties and professionnals but based on the information obtained during the interviews and documentation reviewed it was impossible to determine when and where the injury occurred. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegations are found to be Unsubstantiated. Exit interview conducted and report was reviewed with the facility representative, Victoria Petersen A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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