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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376600031
Report Date: 05/30/2024
Date Signed: 07/16/2024 08:32:01 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 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
04/25/2024 and conducted by Evaluator Annette Sutherland
COMPLAINT CONTROL NUMBER: 51-CC-20240425165400
FACILITY NAME:CARMEL VALLEY PRESCHOOLFACILITY NUMBER:
376600031
ADMINISTRATOR:HOLLY SMITHFACILITY TYPE:
850
ADDRESS:13340 HAYFORD WAYTELEPHONE:
(858) 481-7933
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:125CENSUS: DATE:
05/30/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Holly SmithTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff did not prevent children from engaging in inappropriate behaviors.
INVESTIGATION FINDINGS:
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THIS IS AN AMENDED REPORT
On 5/30/24 at 9:00 AM Licensing Program Analyst (LPA) Annette Sutherland completed an unannounced inspection for the purpose of delivering the finding for the above allegation. LPA met with Director Holly Smith. The initial inspection was conducted on 4/29/24. Throughout the investigation, LPA interviewed staff members, several parents and reviewed relevant and pertinent documentation. The information obtained confirmed that on 2/21/24, there was an incident wherein children interacted inappropriately on the playground. LPA subsequently learned that there were several other inappropriate interactions between children on the playground due to insufficient visual observation.
The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, 101229(a)(1) is being cited on the attached LIC 9099D. LPA Annette Sutherland informed Direcotr Holly Smith that this report dated 5/30/24 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Continued on LIC
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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 51-CC-20240425165400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CARMEL VALLEY PRESCHOOL
FACILITY NUMBER: 376600031
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/31/2024
Section Cited
CCR
101229(a)
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THIS IS AN AMENDED REPORT
CCR 101229(a) Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by:
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The Director stated she had 1:1 meeting with staff members. They now have more staff on the playground and make sure that staff is supervising under the play structure. They have also received training on how to talk to children about respecting their bodies. The Director will hold a staff training meeting where staff will view supervision videos and Director will send LPA a copy of the agenda and attendance sheet via email Annette.Sutherland@dss.ca.gov by 6/30/24.
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Based on interviews with staff and parents and review of documentation, visual supervision was not sufficiently maintained to prevent inappropriate interaction between children on the playground. This poses an immediate risk to the health and safety of 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: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20240425165400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CARMEL VALLEY PRESCHOOL
FACILITY NUMBER: 376600031
VISIT DATE: 05/30/2024
NARRATIVE
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 Also, LPA Annette Sutherland informed the Director Holly Smith to provide a copy of this licensing report dated 5/30/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Director Holly Smith. A printed copy of this report as well as a printed copy of the appeal rights was provided and reviewed with Director at the conclusion of the inspection. LPA's observed the Director post notice of site visit which must remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3