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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702359
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:33:51 PM


Document Has Been Signed on 09/08/2023 01:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CHRIST THE KING LUTHERAN PRESCHOOLFACILITY NUMBER:
561702359
ADMINISTRATOR:SARAH BRITTONFACILITY TYPE:
850
ADDRESS:3947 WEST KIMBER DRIVETELEPHONE:
(805) 499-7022
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY:56CENSUS: 19DATE:
09/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Justine AmbrechtTIME COMPLETED:
01:40 PM
NARRATIVE
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On 9/8/23, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced inspection to the abovementioned Child Care Center (CCC) to conduct a Case Management Inspection with regard to the disenrollement of C1. LPA met with Justine Ambrecht, Assistant Director of the CCC and advised of the purpose of the inspection. It should be noted LPA observed 19 children on site along with 6 teachers providing care and supervision.

C1 was disenrolled from the CCC in July of 2023. The authorized representatives/parents of C1 never initiated the disenrollment process of C1 from the CCC. LPA notes the authorized representatives/parents of C1 spoke to local law enforcement/CCLD with regard to allegations of physical abuse/mistreatment at the CCC prior to C1's disenrollment from the CCC. C1 was disenrolled shortly thereafter. Further, C1 was identified as a child who was subjected to physical abuse/mistreatment at the CCC.

A review of C1's facility file showed no documentation related to authorized representatives/parents initiating the disenrollment of C1 from the CCC. Authorized representatives/parents of C1 informed LPA authorized representatives/parents never contacted the CCC with regard to disenrollement, rather authorized representatives/parents were reviewing the CCC's web site for facility fees and noticed C1's account was not active and C1 had been disenrooled from the CCC.

The facility file did contain an admission agreement 2022-2023 which stated,"I agree to give two weeks prior notice when removing my children from the program." Further the agreement stated, "Christ the King Luther Preschool agrees to give a minimum of 30 days advance written notice of any changes in tuition rates, school hours or policies. The authorized representatives/parents of C1 did not provide the CCC notice C1 was being removed from the program. Likewise, the CCC did not provide C1's authorized representatives/parents a minimum of 30 days advance written notice of any changes in tuition rates, school hours or policies related to disenrollment of children prior to C1 being disenrolled from the CCC. Moreover, the
(CONT. 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHRIST THE KING LUTHERAN PRESCHOOL
FACILITY NUMBER: 561702359
VISIT DATE: 09/08/2023
NARRATIVE
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authorized representatives/parents of C1 were not afforded notice to seek an alternative child care provider for C1 before learning of the disenrollment.

Type B Deficiency being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Assistant Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Assistant Director Justine Ambrecht.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/08/2023 01:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: CHRIST THE KING LUTHERAN PRESCHOOL
FACILITY NUMBER: 561702359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/22/2023
Section Cited
CCR
101218.1(b)(5)

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(b) At the time of acceptance of each child in care, the licensee shall inform each child's parent or authorized representative of his/her rights that include, but are not limited to, the following...(5) To complain to the local licensing office and inspect the child care
center without discrimination or retaliation...
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Licensee to submit a written outline to CCLD (elvin.baddley@dss.ca.gov) by 9/22/23, noting the process by which children in care will be disenrolled from the CCC
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 This requirement is not met as evidenced by C1 being disenrolled from the CCC shortly after the parent of C1's noticing law enforcement/ CCLD of physical abuse/mistreatment at the CCC, which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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