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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702359
Report Date: 09/22/2023
Date Signed: 09/22/2023 12:26:32 PM

Document Has Been Signed on 09/22/2023 12:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CHRIST THE KING LUTHERAN PRESCHOOLFACILITY NUMBER:
561702359
ADMINISTRATOR:SARAH BRITTONFACILITY TYPE:
850
ADDRESS:3947 WEST KIMBER DRIVETELEPHONE:
(805) 499-7022
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 18DATE:
09/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Sarah BrittonTIME COMPLETED:
12:45 PM
NARRATIVE
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On 9/22/23, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced inspection to the abovementioned Child Care Center (CCC) to conduct a Case Management Inspection with regard to violations of Reporting Requirements. LPA met with Sarah Britton, Director of the CCC and advised of the purpose of the inspection. It should be noted LPA observed 18 children on site along with 6 teachers providing care and supervision.

The CCC received written declaration from staff members in February of 2023 detailing S3, a former staff member, sampling eating the food of children in care which was brought from their respective homes. The written declaration also detailed S3 teasing and calling children in care out of their respective names.

The aforementioned is not common or an usual incident at a CCC. Moreover, the matter should have been reported to CCLD as an unusual incident. CCLD data reveals the matter was not reported as an unusual incident upon occurrence and CCLD did received and an Unusual Incident Report form (LIC 624) from the CCC memorializing the incidents within regulatory perimeters.

Type B Deficiency is being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Director was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days or a civil penalty of $100 may apply.

Exit interview conducted and report was reviewed with the Director Sarah Britton.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2023 12:26 PM - It Cannot Be Edited


Created By: Elvin Baddley On 09/22/2023 at 11:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHRIST THE KING LUTHERAN PRESCHOOL
FACILITY NUMBER: 561702359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
101212(d)(1)(C)

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1)...(C) Any unusual incident... that threatens the physical or emotional health or safety of any child. This requirement was not met as Director/CCC staff failed to report an unusual incident to
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Licensee to submit a written outline to CCLD (elvin.baddley@dss.ca.gov) by 10/6/23, noting the process by which unusual incident reports will be reported to CCLD.
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CCLD pertaining to S3 sampling/eating children in care food from home and S3 taunting children in care. This poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Elvin Baddley
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


LIC809 (FAS) - (06/04)
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