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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376701447
Report Date: 09/12/2023
Date Signed: 09/12/2023 02:25:16 PM

Substantiated


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
06/15/2023 and conducted by Evaluator JoAnn R Legaspi
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20230615142208
FACILITY NAME:HSHMC CHILD CARE CENTERFACILITY NUMBER:
376701447
ADMINISTRATOR:KIM DAVIS MANCUSOFACILITY TYPE:
830
ADDRESS:3910 UNIVERSITY AVENUE STE 100TELEPHONE:
(619) 255-9546
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:8CENSUS: 2DATE:
09/12/2023
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Kimberly Davis MancusoTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Infants sleep in cribs with loose articles
INVESTIGATION FINDINGS:
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On September 12th, 2023, at 12:55 PM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an inspection to conclude the complaint investigation regarding the above allegation. LPA advised Director Kimberly Davis Mancuso of the meeting’s purpose and was granted facility entry. There were two (2) infants with three (3) teachers.

The investigation involved interviews with the director, facility staff, daycare parents and older children of the preschool. It also involved a records review including a review of photographs of infants sleeping in their cribs. One photograph depicts one infant sleeping in their crib on their stomach on top of a pillow and blanket. The second photograph shows another infant sleeping in their crib with a blanket which partially covers their mouth. Staff interviews stated that they have seen infants sleeping in their cribs with blankets and pillows. Staff interviews also stated that once they noticed the blankets and pillows, they removed it from the cribs.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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 3
Control Number 20-CC-20230615142208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HSHMC CHILD CARE CENTER
FACILITY NUMBER: 376701447
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2023
Section Cited
CCR
101439.1(f)
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(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

This requirement is not met as evidenced by:



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The director states they will train all current and new staff on Safe Sleep Regulations. The director states they will provide the Department with the training meeting agenda and the sign in/sign out sheet of all staff attending this training. The director said they will also provide the Department with a written
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Based on staff interviews and review of photographs, the Licensee did not comply with the section cited above in that infants slept in their cribs with blankets and pillows, which posed as an immediate health, safety or personal rights to persons in care.
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statement describing how they will ensure all current and new staff are trained on Safe Sleep regulations. The director will also provide the Department with a written statement describing how they will ensure Safe Sleep regulations are followed by all current and future staff.
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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: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 20-CC-20230615142208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HSHMC CHILD CARE CENTER
FACILITY NUMBER: 376701447
VISIT DATE: 09/12/2023
NARRATIVE
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Based on staff interviews and reviews of photographs the preponderance of evidence standard has been met, therefore the allegation of infants sleeping in cribs with loose articles is found to be SUBSTANTIATED, California Code of Regulations, Title 22, Division 12 Chapter 1 is being cited on the attached LIC 9099D.

The Notice of Site Visit (LIC 9213) was provided to the director, which is to be posted at the facility for 30 days. LPA observed form LIC 9213 posted on the front parent board by the front door.

AB633 requires upon receipt, the director shall post a Type A violation and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file. LPA provided the director with one blank LIC 9224 form.

An exit interview was conducted with Director Kimberly Davis Mancuso. Appeal Rights (LIC 9098) along with a copy of this report was provided to Director Kimberly Davis Mancuso.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3