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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566211192
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:40:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2021 and conducted by Evaluator Laura Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20210913165348
FACILITY NAME:PVSD-DOS CAMINOS ELEMENTARY SCHOOLFACILITY NUMBER:
566211192
ADMINISTRATOR:MARK ASHERFACILITY TYPE:
850
ADDRESS:3635 APPIAN WAYTELEPHONE:
(805) 482-9894
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:25CENSUS: 0DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Stephanie LawsonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not properly supervise daycare child
Staff did not properly observe daycare child's behaviors
INVESTIGATION FINDINGS:
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On November 5, 2021 at 1:40 PM Licensing Program Analyst (LPA) Laura Villanueva made a visit to conclude a complaint investigation received on 8/11/21. LPA met with Program Manager, Stephanie Lawson at the Pleasant Valley School District Administration Office.

LPA interviewed Program Manager and obtained emails showing the actions taken by the preschool program to support child's needs. There is evidence of reporting party and child's mother having conflicts over the child's behavior in the classroom. The Program Administrator addressed the child's needs and a referral was made to the school Psychologist. The child was evaluated on 11/4/2019. The child's behavior was deemed to be the concern. A plan was developed of a positive reinforcement chart along with strategies to working with the child. The child did not qualify for intervention services. The Psychologist offered guidance to help with child's language outbursts and aggresive behavior.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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 2
Control Number 17-CC-20210913165348
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PVSD-DOS CAMINOS ELEMENTARY SCHOOL
FACILITY NUMBER: 566211192
VISIT DATE: 11/05/2021
NARRATIVE
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 Based on documentation and interviews with Program Manager and Reporting Party, the allegations are not corroborated. Although these allegations may have occurred, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore, the allegations listed above are deemed UNSUBSTANTIATED..

An exit interview was conducted and a copy of this report was given to Program Manager.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2