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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444417183
Report Date: 01/13/2025
Date Signed: 01/13/2025 05:57:24 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2025 and conducted by Evaluator Elizabeth Larios
COMPLAINT CONTROL NUMBER: 07-CC-20250108154210
FACILITY NAME:SIMCHA PRESCHOOLFACILITY NUMBER:
444417183
ADMINISTRATOR:CAITLIN CLANCYFACILITY TYPE:
860
ADDRESS:3055 PORTER GULCH ROADTELEPHONE:
(831) 479-3444
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:52CENSUS: 47DATE:
01/13/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Barbara LitskyTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff left day care child unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Elizabeth Larios conducted an initial unannounced complaint investigation. LPA met with Acting Director Babara "Gaby" Litsy and explained the purpose of today's visit.

During the course of this investigation, LPA conducted interviews with staff, children, and third party. LPA also reviewed and obtained pertain documents. On January 8, 2025 a child (C-1) was left unattended on the play yard without staff supervision while assigned Teacher (S-1) went inside classroom with the rest of the children. Child (C-1) was redirected by another Teacher (S-2) to her asssigned Teacher (S-1) who was not aware of leaving child (C-1) behind in the play yard. Based on the information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Type A deficiency was cited and is noted on the attached page (LIC 9099-D).

====CONTINUE ON LIC 9099-C====

Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
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 3
Control Number 07-CC-20250108154210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SIMCHA PRESCHOOL
FACILITY NUMBER: 444417183
VISIT DATE: 01/13/2025
NARRATIVE
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LPA discussed the requirements of AB633 to Gaby and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and understands the requirements.

Exit interview was conducted, where this report was reviewed and discussed with Gaby. A copy of this report was also provided. Appeal rights were given.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20250108154210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SIMCHA PRESCHOOL
FACILITY NUMBER: 444417183
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2025
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision
(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 shall submit a written Plan of Correction (POC) to LPA indicating what steps that will be implemented to ensure that the day care children are supervised at all times and conducted staff training, by POC due date 1/14/2025. Assess a civil penalty of $500.
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This requirement was not met as evidenced by: On January 8, 2025 a child (C-1) was left unattended on the play yard without staff supervision while assigned Teacher (S-1) went inside the classroom with rest of children. Child (C-1) was redirected by another Teacher (S-2) to her asssigned Teacher (S-1) who was not aware of leaving child (C-1) behind in the play yard. This poses an immediate threat to the health and safety of children in care.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file.
Type B
01/20/2025
Section Cited
CCR
101212(d)(1)
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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

(1) Events reported shall include the following:

(A) Death of any child from any cause.

(B) Any injury to any child that requires medical treatment.

(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

(D) Any suspected physical or psychological abuse of any child.

(E) Epidemic outbreaks.

(F) Poisonings.

(G) Catastrophes.

(H) Fires or explosions that occur in or on the premises.
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Director shall submit a written Plan of Correction to ensure that unusual incidents shall be reported to Licensing within the required time frame. In addition, a completed Unusual Incident/Injury Report (LIC 624) pertaining to the incident occurred on 01/08/25 and be sent to Licensing.
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This requirement was not met as evidenced by: Licensing did not receive a telephone call or report within the next working day in regards to incident that happen on January 8, 2025 where a child (C-1) was left unattended on the play yard 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: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC9099 (FAS) - (06/04)
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