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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313623318
Report Date: 12/06/2021
Date Signed: 12/06/2021 11:30:08 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2021 and conducted by Evaluator Blake Morillas
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20211130084452
FACILITY NAME:LILY PAD EARLY LEARNING CENTER, INC.FACILITY NUMBER:
313623318
ADMINISTRATOR:ZEMLICKA, MICHELLEFACILITY TYPE:
850
ADDRESS:1388 LINCOLN WAYTELEPHONE:
(530) 863-9443
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:33CENSUS: 23DATE:
12/06/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Michelle Zemlicka - DirectorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility is not following COVID-19 requirements by not wearing masks.

INVESTIGATION FINDINGS:
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On Monday, December 6th, 2021, at 8:47am, Licensing Program Analyst (LPA) Blake Morillas made an unannounced visit to the facility and met with the Director, Michelle Zemlicka, in order to initiate the complaint investigation into the above allegations. Upon arrival, 23 preschool children and several staff were observed. The complaint alleged that the Facility is not following Covid-19 requirements by not wearing masks. According to Provider Information Notice (PIN) 21-29-CCP, ". . . all individuals in child care sittings to wear face covering while indoors regardless of vaccination status." When speaking with the director, she stated that there are disposable masks for the children to wear while inside the facility. The children are asked if they would like to wear a mask when in doors. If the child does not want to wear a mask indoors they are not forced to do so. When asked about staff, the Director stated that staff will for the most part wear masks indoor, but will remove them when delivering instruction or participating in other interactions with the children. Being that the Director freely admitted that staff don't always wear their masks while indoors, the preponderance of evidence was met through interviews and observation; the above allegation was found to be SUBSTANTIATED. As a result of the findings and this being a repeat violation of current Covid-19 guidelines, a Type B Deficiency was cited and noted on the subsequent pages of this report (Please see 9099-D). The report was reviewed with the Director and an exit interview was conducted. Notice of site visit to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
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 2
Control Number 03-CC-20211130084452
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LILY PAD EARLY LEARNING CENTER, INC.
FACILITY NUMBER: 313623318
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2022
Section Cited
CCR
101223(a)(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations,. . . . This requirement was not met as evidenced by the admission of the Director.
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LPA B Morillas provided the director a copy of PIN 21-29-CCP that goes over in detail the latest face covering requirements and guidance for child care providers regarding Covid-19.
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The Director freely admitted while in doors, sometimes the staff will remove their masks while delivering instructions or interacting with the children. This is a potential health and safety risk to children in care.
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The director was also instructed to research and provide face coverings to staff that would be both conducive to delivering instructions to children in care as well as being compliant with current Covid-19 masking guidelines.
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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: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2