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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561702359
Report Date: 11/07/2023
Date Signed: 11/07/2023 02:37:52 PM

Document Has Been Signed on 11/07/2023 02:37 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
SANTA BARBARA CC RO, 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: 7DATE:
11/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Sarah BrittonTIME COMPLETED:
02:52 PM
NARRATIVE
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On November 07, 2023, Licensing Program Analysts (LPAs) Susana Martinez and Veronica Diaz conducted an unannounced Case Management- incident inspection. LPA's met with Director Sarah Britton and advised the purpose of the inspection. LPA's were provided a tour of the facility. There were seven children in care at the time of the inspection.

On 11/06/2023, Director Sara Britton contacted Community Care Licensing (CCL) to self-report an incident of a child (C1) touching another child (C2) inappropriately. Director stated that teacher (S1) observed the incident which occurred around 12:45 PM.

LPA's conducted an interview with S1 and determined, (S1) was outside at the time of incident along with another staff member (S2). S1 states she was diagonally placed and demonstrated to LPA's her position. S1 states they had to turn back to see C1 and C2. S1 states she noticed C2 sitting on an adult chair placed in front of the sink. S1 noticed C2's pants were down and saw C1 in front of C2 inappropriately touching C2. S1 states she walked over to the children and had C2 pull up pants and washed C1's hands.

LPA's asked S1 if there were any other staff members outside at the time of incident. S1 stated S2 was taking children to the bathroom at the time of the incident. LPA's reviewed the children's sign-in/sign-out log and determined the facility was in ratio at the time of inspection.

LPA's determined that the incident was true and did occur. Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate. The following CCR, Title 22, Division 12 regulation was discussed: 101229(a)(1) Responsibility for Providing Care and Supervision.One type B deficiency was issued during today's inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted appeal rights were given and report was reviewed with Director Sarah Britton.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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 11/07/2023 02:37 PM - It Cannot Be Edited


Created By: Susana Martinez On 11/07/2023 at 02:19 PM
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: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/21/2023
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
101229(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. This requirement was not met as evidence by:
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Center has agreed to submit a written statement on how similar incidents will be prevented in the future. Director states she will be talking to all staff. LPA recommends staff watch videos on the CCLD website regarding Supervising Children in Centers.
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Based on LPAs observation, interview, record review, the licensee did not comply with the section cited above as two children were not under visual observation at all times which posed 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:Ana Tolentino
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023


LIC809 (FAS) - (06/04)
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