Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376700376
Report Date: 04/19/2018
Date Signed 04/19/2018 11:26:10 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2018 and conducted by Evaluator James Wilkerson
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20180412111025
FACILITY NAME:CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMSFACILITY NUMBER:
376700376
ADMINISTRATOR:JUDI PESHEKFACILITY TYPE:
850
ADDRESS:453 LA MOREE ROADTELEPHONE:
(760) 750-8750
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:144CENSUS: 94DATE:
04/19/2018
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Judi PeshekTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to provide adequate supervision resulting in child sustaining an injury while in care.

Director failed to provide authorized representative with a copy of a Type A citation.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) James Wilkerson and Reggie Smith arrived at this facility to conduct an investigation into the above allegations. LPAs met with Director, Judi Peshek and discussed the matter. Ms. Peshek stated that there was an incident brought to her attention regarding a child being bitten and staff was unaware of it. Ms. Peshek stated that this incident did in fact happen. Ms. Peshek stated that there was an incident where a parent/guardian was "overlooked" when it came time to sign the form LIC 9224 (Acknowledgment of Receipt of LIcensing Reports) for a type "A" from a report dated 01/09/18 until it was brought to the facility's attention. Ms. Peshek stated that she believes the allegation of the child being bitten did happen here as the child has no siblings and there is a child in the classroom that has a history of biting and staff did observe the child being bitten by the other child the following day. From the information received from Ms. Peshek's disclosures the above allegations will be substantiated. The citation issued for lack of supervision is a violation of the same subsection within a 12 month period and will result in a civil penalty. See LIC 9099Ds for citations issued.

See LIC 9099 for continuance of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2018
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 4
Control Number 09-CC-20180412111025
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376
VISIT DATE: 04/19/2018
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A Civil Penalty has been assessed on this visit. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Upon receipt, licensee shall post 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 for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was conducted, appeal rights discussed and provided on this date along with a copy of form LIC 9224 (AB 633) and a copy of this report on this date.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 09-CC-20180412111025
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2018
Section Cited
HSC
1596.8595(c)
1
2
3
4
5
6
7
Health and Safety Code Section 1596.8595 (c) A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to health, safety, or personal rights of
1
2
3
4
5
6
7
Director, Ms. Peshek agrees to be more proactive in handing out type "A" citations to parents/guardians and providing for LIC 9224 to them as well. A copy of the facility correction plan will be submitted to Community Care Licensing by 05/18/18.
8
9
10
11
12
13
14
children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2018
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 09-CC-20180412111025
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CENTER FOR CHILDREN & FAMILIES AT CAL STATE SMS
FACILITY NUMBER: 376700376
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2018
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). A child was bitten by another child and staff was unaware of the incident. This will result in a civil penatly because this
1
2
3
4
5
6
7
Director, Ms. Peshek agrees to meet with staff and submit of a signed agenda regarding supervision to CCL by 04/19/18.
8
9
10
11
12
13
14
the second violation of this subsection within a 12 month period.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2018
LIC9099 (FAS) - (06/04)
Page: 3 of 4