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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370698
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:21:36 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-20230307085737
FACILITY NAME:COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCHFACILITY NUMBER:
304370698
ADMINISTRATOR:FERGUSON, JENNIFERFACILITY TYPE:
830
ADDRESS:27005 BURBANK ROADTELEPHONE:
(949) 380-4300
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY:12CENSUS: 4DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jennifer Ferguson, DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility has mold.
Facility is in disrepair.
Staff are falsifying sign in/sign out documents.
INVESTIGATION FINDINGS:
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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 4 infants supervised by 1 staff in the infant 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 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 5
Control Number 06-CC-20230307085737
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: 304370698
VISIT DATE: 04/14/2023
NARRATIVE
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(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 03/10/2023, and interviewed 5 staff on 03/16/2023, and sign in/out sheets for the month of February.

During the inspection on 03/10/23, 03/16/2023 and on 04/14/2023, LPA did not observe any disrepair and any mold in the infant classroom.

During interviews, all interviewed staff denied that they have seen any disrepair or mold in the infant classroom 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 record review, LPAs reviewed facility's sign in/out sheets for the month of February. LPA observed 1 child'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.

Based on the information gathered from LPAs' observation on 03/10/23, 03/16/2023 and on 04/14/2023, interviews conducted with 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, there is insufficient evidence to corroborate the allegations that facility has mold, facility is in disrepair, and 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, facility has mold, facility is in disrepair, staff are falsifying sign in/sign out documents, did or did not occur, therefore the allegations, 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.
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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 5
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-20230307085737

FACILITY NAME:COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCHFACILITY NUMBER:
304370698
ADMINISTRATOR:FERGUSON, JENNIFERFACILITY TYPE:
830
ADDRESS:27005 BURBANK ROADTELEPHONE:
(949) 380-4300
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY:12CENSUS: 4DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jennifer Ferguson, DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Unqualified staff are providing care and supervision to day care children.
Facility operates out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (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 4 infants supervised by 1 staff in the infant 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 unqualified staff are providing care and supervision to day care children and 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: 3 of 5
Control Number 06-CC-20230307085737
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: 304370698
VISIT DATE: 04/14/2023
NARRATIVE
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(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 #1 (S1) stated and staff #11 (S11) had given breaks to S1 daily approximately 15-30 minutes in the morning and in the afternoon in the infant classroom. When interviewed, S11 confirmed that S11 gave breaks for S1 and were working alone with up to 4 infants in the infant classroom. Director stated that Director did not know that staff # 11 did not have Infant/Toddler units.

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

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, due to having unqualified staff working alone with the infants, facility is operating out of ratio, the preponderance of evidence standard has been met, therefore the above allegations, unqualified staff are providing care and supervision to day care children and facility operates out of ratio are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 12 Chapter 1, Sub Chapter 2 Section 101416.2 (b) Infant Care Teacher Qualifications and Duties and Section 101416.5 (b) Staff-Infant Ratio, are 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

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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: 4 of 5
Control Number 06-CC-20230307085737
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: 304370698
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(b)
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101416.5 Staff-Infant Ratio (b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement was not met evidenced by:
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Director stated that she will submit a statement of understanding of the regulation and detailed plan to ensure ratio are being met, to LPA by due date.
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Based on LPAs interviews and record review, S#11 did not meet qualification to work in the infant classroom and had worked in the infant classrooms on multiple occasions, this posed an immediate risk to the health, safety and personal rights of the children in care
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Type B
04/28/2023
Section Cited
CCR
101416.2(b)
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101416.2 Infant Care Teacher Qualifications and Duties (b) Prior to employment, an infant care teacher shall have completed... units related to the care of infants, at an accredited or approved college or university.
This requirement is not met evidenced by:
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Director stated that she will submit a statement of understanding of the regulation and detailed plan to ensure staffing qualifications are met.
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Based on LPAs interviews and record review, S#11 did not complete 3 units in Toddler/Infant care prior to working in the infant classroom, this posed a potential risk to the health, safety and personal rights of the children 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.
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: 5 of 5