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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370846
Report Date: 04/12/2021
Date Signed: 04/12/2021 05:24:59 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
12/17/2020 and conducted by Evaluator Leonor Barajas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20201217133151
FACILITY NAME:NOBIS PRESCHOOLFACILITY NUMBER:
304370846
ADMINISTRATOR:SANCHEZ, CARLAFACILITY TYPE:
850
ADDRESS:26153 VICTORIA BLVD.TELEPHONE:
(949) 661-6258
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:45CENSUS: 19DATE:
04/12/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Director Ashley Neitzke TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility is operating out of ratio
Staff allowed children to use the bathroom without supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Barajas, conducted an unannounced complaint inspection to deliver findings. LPA met with Director Ashley Neitzke. Director Ashley guided LPA on a tour of the facility. During inspection LPA observed 7 preschool children having lunch with 1 staff Maribel Manhorn and 12 preschool children in playground with 2 staff April N and Jessica Rose. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have/have not received criminal record and child abuse index clearances or exemptions.

During the investigation LPA interviewed Director, 4 staff members, no children due to children’s ages and language abilities, 6 out of 8 parents, conducted an inspection on 12/22/2020, reviewed personnel report, requested an updated children’s roster LIC 9040, was provided a new updated facility sketch, requested sign in sign out sheets, and incident reports.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
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 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
VISIT DATE: 04/12/2021
NARRATIVE
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The Complainant Party (C/P) reported an allegation: Facility is operating out of ratio. C/P disclosed that she has cared for up to 13 children alone.

During interview conducted with current Director. Director disclosed that she started working at the facility as of 12/21/2020. Director disclosed previous Director: Carola Sanchez last day worked was 12/18/2020. Director disclosed that she currently has enough staff and if needed she steps in and helps in classrooms. Director disclosed that she has no incident reports for alleged incident of child#6. Director disclosed she is not aware of what occurred before she began working at facility, no documents available for review.

During interviews conducted with 4 Staff, 2 staff disclosed each had 13 children in classroom by themselves on 12/15/2020 and 12/17/2020. Staff disclosed facility was short staff therefore were out of ratio. A staff disclosed facility would be out of ratio when Child#9 would attend, the child only attends day care twice a week. Staff disclosed on 12/15/20 and 12/17/20 when the Director left home early at 3pm, this caused one of the classrooms to be out of ratio. Previous director admitted that when had to leave the facility, this would cause a classroom to go out of ratio. Previous director disclosed had to help in classroom as facility was short staff. A staff disclosed, did not have ratio issues. A Staff disclosed facility has been out of ratio 2-3 times since staff began working at the facility. Staff disclosed when facility has been out of ratio, previous director is informed.

During Interviews conducted with 6 of 8 Parents, Parents disclosed facility has enough staff and have observed between 8-10 staff. Parents disclosed due to COVID they are not allowed to enter facility therefore are not aware of how many staff work at day care. Two parents mentioned facility has had a high turnover of staff. All parents disclosed they have no concerns.

Based on LPA interviews conducted with 5 Staff, 6 of 8 Parents and records reviewed, the facility failed to comply with staffing/ratio requirements. This requirement was not met as staff disclosed during interviews of exceeding maximum capacity of 12 to 1, by being out of ratio with 13 children with 1 staff in two preschool classrooms on 12/15/20 and 12/17/20. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Section 101216.3(a) is being cited on the attached deficiencies page.
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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
VISIT DATE: 04/12/2021
NARRATIVE
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101216.3(a) Teacher-Child Ratio: (a)There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

The Complainant Party (C/P) reported a second allegation: Staff allowed children to use the bathroom without supervision. C/P disclosed on 12/17/20 as a result of being out of ratio a child was left in the bathroom for 15 minutes and came out crying.

During interview conducted with current Director. Director disclosed that she started working at the facility as of 12/21/2020. Director disclosed previous Director: Carola Sanchez last day worked was 12/18/2020. Director disclosed that she currently has enough staff and if needed she steps in and helps in classrooms. Director disclosed that she has no incident reports for alleged incident of child#6. Director disclosed she is not aware of what occurred before she began working at facility, no documents available for review.

During interviews conducted with 4 Staff, the 3 of 4 staff disclosed bathroom is in the middle of the three classrooms, between Room#1 and Room#2. Staff disclosed if children need to use the restroom, they will send them and stand at the door and watch children and classroom at same time. Children sent to the restroom are self-sufficient, in transitional kindergarten. Staff disclosed children are never unsupervised, always being watched. A staff disclosed if they are outside in the playground and they are short staff and a child/ren need to use restroom, staff will line up all children and they all go to restroom. If there are two staff out in the playground, then one staff will take the children to the restroom while the rest of children play outside. A staff disclosed that child#6 was left alone in the restroom it is unclear who left the child in the restroom or how the child ended up in the restroom alone, while classroom was outside in playground. Staff disclosed child#6 was left alone for about 5-10 minutes, until a staff finished setting up mats and realized a child was in another classroom alone. A staff disclosed hearing about incident regarding child#6. The teacher in charge of the classroom when the incident occurred, the class was having lunch outside, when the teacher realized there was a child missing. Staff disclosed took class back inside classroom, to look for child. Staff disclosed found child sitting in classroom table playing with toys. Staff disclosed was working as a teacher, due to being short staff.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
VISIT DATE: 04/12/2021
NARRATIVE
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All staff disclosed if an incident occurs at facility, the Director will notify parents at pick up time and the more serious incidents, the Director will contact parents immediately and provide an incident report. Staff#5 disclosed never wrote incident report, did not report incident to parent or licensing department.

During Interviews conducted with 6 of 8 Parents, Parents disclosed facility has enough staff and have observed between 8-10 staff. Parents disclosed communication is good with staff, if any incident occurs parents are notified at pick up time. All parents disclosed they have no concerns.

Based on LPA interviews conducted with 5 Staff, 6 of 8 Parents and records reviewed, the facility failed to supervise children by leaving child#6 alone inside the classroom for 5-10 minutes without adult visual/absence of supervision. This requirement was not met as two staff disclosed during interviews, child was left alone inside classroom unsupervised for 5-10 minutes, after staff counted children and realized was missing 1 child. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Section 101229(a)(1) Responsibility for Providing Care and Supervision is being cited on the attached LIC 9099D deficiencies page. Also, an immediate $500 civil penalty is being issued today.

Additionally, child absence for 10-15 minutes was not reported to parents in a timely manner, nor to Licensing Department as an Unusual Incident Report (LIC 624) therefore, the preponderance of evidence standard has been met, the facility is being cited under Title 22, Reporting Requirements 101212(d)(1)(C ), please see attached LIC 9099D.

101229(a)(1)Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
VISIT DATE: 04/12/2021
NARRATIVE
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101212(d)(1)(C) Reporting Requirements: d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

This report cites a Two Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview was conducted with Director Ashley Neitzke via Tele-Inspection. Report was read to Director. A copy of the report along with Appeal Rights will be emailed to Director with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Director will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available.

End of Report
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/13/2021
Section Cited
CCR
101216.3(a)
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101216.3(a) Teacher-Child Ratio: (a)There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement was not met as evidenced by:
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Director stated already hired 4 new staff and now have an extra floater and Director is at facility all day. There is plenty of staff on hand. Director will email a plan correction to LPA via email due by 04/13/2021
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Based on interviews conducted with 5 Staff, staff disclosed during interviews of exceeding maximum capacity of 12 to 1, by being out of ratio with 13 children with 1 staff in two preschool classrooms on 12/15/20 and 12/17/20. This poses an immediate safety risk for the children in care.
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Type A
04/13/2021
Section Cited
CCR
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101229(a)(1)Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child shall be left without the supervision of a teacher at any time, except as specified...Supervision shall include visual observation. This req was not met as evidenced by:
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Director stated has had two meetings to go over supervision, Director will show staff Supervision video provided by licensing dept. Director will email plan of correction to LPA and signatures that prove staff viewed supervision video due by 04/13/2021.
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Based on interviews conducted the facility failed to supervise children by leaving child#6 alone inside the classroom for 5-10 minutes without adult visual supervision. Two staff disclosed during interviews, child was left alone inside classroom unsupervised for 5-10 minutes, after staff
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counted children and realized was missing 1 child. This poses an immediate safety risk for the children in care.
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: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 06-CC-20201217133151
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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2021
Section Cited
CCR
101212(d)(1)(C)
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101212(d)(1)(C) Reporting Req: d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) ... In addition, a written report containing the information specified in (d)(2)... (1) Events reported shall include the following: (C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.This requirement was not met as evidence by:
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Director stated as plan of correction moving forwarded will be contacting dept within 24 hours and submitting LIC 624 via mail as required for any unusual incident report. Director will email LPA a plan of correction due by 04/19/2021
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Based on interviews conducted and records reviewed the child's absence for 10-15 minutes was not reported to parents in a timely manner, nor to Licensing Department as an Unusual Incident Report (LIC 624) This poses a potential immediate threat to the health and safety of 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: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021
LIC9099 (FAS) - (06/04)
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