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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370432
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:17:21 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, 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
03/07/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230307083240
FACILITY NAME:COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCHFACILITY NUMBER:
304370432
ADMINISTRATOR:FERGUSON, JENNIFERFACILITY TYPE:
850
ADDRESS:27005 BURBANK ROADTELEPHONE:
(949) 380-4300
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY:158CENSUS: 47DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jennifer Ferguson, DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff member is physically aggressive with day care children.
Staff member is verbally aggressive with day care children.
Facility has mold.
Facility is in disrepair.
Staff are falsifying sign in/sign out documents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Nguyen Tran and LPA Nunez conducted a subsequent investigation at the facility and delivered the complaint findings. LPA met with Director Jennifer Ferguson. Census was taken in individual classrooms. The overall census observed was 42 preschool children supervised by 5 staff in 5 classrooms and 5 toddlers supervised by 1 staff in the toddler classroom.

A review of staff criminal clearance records on 04/14/2023, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/07/2023 a complaint was filed with the Licensing office alledge, staff member is physically aggressive with day care children, staff member is verbally aggressive with day care children, facility has mold, facility is in disrepair, staff are falsifying sign in/sign out documents.
(Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
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 7
Control Number 06-CC-20230307083240
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/14/2023
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 2 of Report)

During the investigation, LPAs inspected the facility on 03/10/2023, 03/16/2023 and on 04/14/2023, interviewed 5 staffs and 9 children on 03/10/2023, and interviewed 5 staff on 03/16/2023, and obtained facility's staff's and children roster, sign in/out sheets for the month of February, and facility's work orders.

During the inspection on 03/10/23, LPA observed ceiling tiles were damaged in classroom #5 and in classroom #11 and a non-functional toilet in classroom # 7. Facility provided pending work orders to fix the ceiling tiles in the classrooms # 5 and #11 and toilet in classroom #7. During inspection on 03/16/2023, LPAs observed the ceiling tiles had been fixed in classroom #5 and classroom #11. During the inspection on 04/14/2023, LPAs observed toilet in room #7 was fixed. During all 3 inspection dates, LPAs did not observe any mold in the classrooms that are currently in use.

During interviews, all interviewed staff denied that they ever witnessed or heard of any staff being physical and verbally aggressive toward the children. All interviewed staff were aware of the water damage to the ceiling tiles and toilet and they were aware that those issues were pending repairs. All interviewed staff denied that they had seen mold in the facility and denied of knowing any staff would falsifying parent's signature on the sign in/out sheets. All interviewed staff stated that if parents forget to sign, the Director will check and follow up with parents with reminders. Director stated she put her initial and the school's abbreviation on sign in/out sheets if parents forget to sign and remind parents to sign in/out for their child upon pick-up and drop-off. During interviews with the children on 03/10/2023, 6 out of 9 children were qualified for the interview, and all 6 interviewed children denied that any staff was being physically or verbally aggressive toward them.

During record review, LPAs reviewed facility's sign in/out sheets for the month of February, and facility's work orders. When reviewed the sign in/out sheets, LPA observed 16 children's sign in/out sheets with missing parent's signatures, however, there were Director's initial and facility's abbreviation in those missing signature dates. When reviewed facility's work orders, facility had evidence that work orders were submitted promptly to get the ceiling tiles and the toilet repaired.

(Continue next page)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 06-CC-20230307083240
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/14/2023
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 3 of Report)

Based on the information gathered from LPAs' observation on 03/10/23, 03/16/2023 and on 04/14/2023, interviews conducted with 6 children on 03/10/2023 and 10 staff on 03/10/2023 and on 03/16/2023 and record review of facility's sign in/out sheets in the month of February and facility's work orders, there is insufficient evidence to corroborate the allegations that staff member is physically aggressive with day care children, staff member is verbally aggressive with day care children, facility has mold, facility is in disrepair, staff are falsifying sign in/sign out documents. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged, staff member is physically aggressive with day care children, staff member is verbally aggressive with day care children, facility has mold, facility is in disrepair, staff are falsifying sign in/sign out documents, did or did not occur, therefore the allegations, staff member is physically aggressive with day care children, staff member is verbally aggressive with day care children, facility has mold, facility is in disrepair, staff are falsifying sign in/sign out documents are UNSUBSTANTIATED.

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058) was provided. First level appeal is to Regional Manager, address is above on the report.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
03/07/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230307083240

FACILITY NAME:COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCHFACILITY NUMBER:
304370432
ADMINISTRATOR:FERGUSON, JENNIFERFACILITY TYPE:
850
ADDRESS:27005 BURBANK ROADTELEPHONE:
(949) 380-4300
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY:158CENSUS: 47DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jennifer Ferguson, DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility operates out of ratio.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Nguyen Tran and LPA Nunez conducted a subsequent investigation at the facility and delivered the complaint findings. LPA met with Director Jennifer Ferguson and informed her of the purpose of the investigation. Census was taken in individual classrooms. The overall census observed was 42 preschool children supervised by 5 staff in 5 classrooms and 5 toddlers supervised by 1 staff in the toddler classroom.

A review of staff criminal clearance records on 04/14/2023, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 03/07/2023 a complaint was filed with the Licensing office alledge facility operates out of ratio.
(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 06-CC-20230307083240
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/14/2023
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 2 of Report)

During the investigation, interviewed 5 staffs on 03/10/2023 and interviewed 5 staff on 03/16/2023, and obtained facility's staff's and children roster and staff files.

During interviews, staff #2 (S2) confirmed that Staff #4 (S4) had given breaks to S2 daily approximately 15-30 minutes in the morning and in the afternoon in the toddler classrooms, and staff #11 (S11) had given breaks to S2 daily approximately 15-30 minutes in the morning and in the afternoon in the toddler classrooms. When interviewed, S4 and S11 confirmed that they gave breaks for S2 and were working alone with up to 6 toddlers in the toddler classrooms.

During record review, LPA reviewed 8 staff files and discovered staff #4 and staff #11 did not have any units in toddler and infant courses. S4 and S11 did not meet teacher qualifications to work alone with the toddlers.

Based on the information gathered from LPAs' interviews conducted with 10 staff on 03/10/2023 and on 03/16/2023, and record review of 8 staff files, although the toddler component is an additional component to the preschool license, the toddler classroom requires a fully qualified teacher to be in ratio with 6 toddlers. Due to having unqualified staff, S4 and S11, working alone with the toddlers, facility is operating out of ratio in the toddler component, the preponderance of evidence standard has been met, therefore the above allegation facility operates out of ratio is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 12 Chapter 1, Sub Chapter 2 Section 101416.5(b) Staff-Infant Ratio is being cited on the attached LIC9099D.

Due to the Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

(Continue next page)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 06-CC-20230307083240
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/14/2023
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 3 or Report)

Appeal Rights and deficiencies were discussed. The facility representative 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Jennifer Ferguson.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 06-CC-20230307083240
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2023
Section Cited
CCR
101416.5(b)
1
2
3
4
5
6
7
101416.5 Staff-Infant Ratio (b) There shall be a ratio of one teacher for every four infants in attendance.

This requeriment was not met evidenced by:
1
2
3
4
5
6
7
Director stated that she will submit a statement of understanding of the regualtion and detailed plan to ensure ratio are being met, to LPA by due date.
8
9
10
11
12
13
14
Based on LPAs interviews and record review, S#2 and S#11 did not meet qualification to work in the Toddler classroom and had worked in the Toddler classrooms on multiple occasions, this posed an immediate risk to the health, safety and personal rights of 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: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7