<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270947
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:08:07 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2023 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230619140220
FACILITY NAME:CALVARY CHAPEL PACIFIC COAST-LITTLE LIGHT P/SFACILITY NUMBER:
304270947
ADMINISTRATOR:ISAACSON, KRISTINAFACILITY TYPE:
850
ADDRESS:6400 WESTMINSTER BLVD.TELEPHONE:
(714) 349-6933
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:120CENSUS: 62DATE:
06/21/2023
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Director, Kristina IsaacsonTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not keep the facility free from cockroaches.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
A complaint inspection was conducted on this date by Licensing Program Analyst (LPA) Cindy Nguyen, in response to the above allegation. Upon arrival LPA met with Director, Kristina Isaacson who accompanied LPA on a tour of the facility. Census was taken as follow: 59 preschool and 3 school age children with 8 staff members. During today's inspection staffing and capacity ratios were met. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 06/19/23 a complaint was filed with the Licensing Office. Complainant alleged the building staff do not keep the facility free from cockroaches. Complainant stated that the building staff has exterminated, but there are still cockroaches in the building.

Continued on Page 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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 06-CC-20230619140220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CALVARY CHAPEL PACIFIC COAST-LITTLE LIGHT P/S
FACILITY NUMBER: 304270947
VISIT DATE: 06/21/2023
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
Page 9099C

During today’s investigation, LPA interviewed six staff. Five out of the six staff stated they have observed or heard of someone who observed cockroaches inside the kitchen. LPA review pictures of cockroaches provided by the complainant.

Based on LPA observations, review of cockroaches pictures, and interviews with staff who mentioned seeing cockroaches in the kitchen, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Buildings and Grounds 101238 (a)(1) is being cited on the attached LIC 9099D.

Exit interview was conducted with Director, Kristina Isaacson. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights and deficiency were discussed. Director, Kristina Isaacson was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20230619140220
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CALVARY CHAPEL PACIFIC COAST-LITTLE LIGHT P/S
FACILITY NUMBER: 304270947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2023
Section Cited
CCR
101238(a)(1)
1
2
3
4
5
6
7
101238 Buildings and Grounds (a)The child care center shall be clean, safe, sanitary.. (1) The licensee shall take measures to keep the center free of flies, other insects, and rodents. This requirement was not met evidence by:
1
2
3
4
5
6
7
Director stated they will schedule a regular routine spraying the kitchen and provide a written preventative maintenance plan to LPA by 7/5/2023.
8
9
10
11
12
13
14
Based on pictures and interviews with staff members stating they have observed cockroaches in the kitchen on different dates. This is a potential Health and Safety risk to the children in care.
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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3