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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570300647
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:14:13 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2024 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240422120902
FACILITY NAME:ST. LUKE'S PRESCHOOLFACILITY NUMBER:
570300647
ADMINISTRATOR:LAURIE MOOREFACILITY TYPE:
850
ADDRESS:515 SECOND STREETTELEPHONE:
(530) 662-1853
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:44CENSUS: 16DATE:
04/29/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:lead teacher, Carissa TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Classroom operating out of ratio.
INVESTIGATION FINDINGS:
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On April 29, 2024, Licensing Program Analysts (LPAs) Lauren Scott met with lead teacher, Carissa Crain, to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPA's conducted interviews, and obtained information pertaining to allegation. It was alleged that the classroom is operating out of ratio. Through interviews, review of staff schedule's and review of children's sign in and out sheets, LPAs were able to determine the facility has operated over ratio on at least one occassion (4/29/24).

Based on the interviews and review of records, it was revealed facility did not fully adhere to proper ratios, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page.

Report continues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
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 3
Control Number 53-CC-20240422120902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST. LUKE'S PRESCHOOL
FACILITY NUMBER: 570300647
VISIT DATE: 04/29/2024
NARRATIVE
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An exit interview was conducted with the facility representative. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Scott informed facility representative, Carissa Crain, that this report dated April 29, 2024, documents one Type A citation. Type A citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Scott informed the facility representative to provide a copy of this licensing report dated, April 29, 2024, that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240422120902
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ST. LUKE'S PRESCHOOL
FACILITY NUMBER: 570300647
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/30/2024
Section Cited
CCR
101216.3(a)
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(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

This requirement was not met as evidenced by:
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Director will call in additional staff as needed and not accept children to ensure ratio is met.
Facility will update staff schedule's and submit an updated LIC500, to make sure ratios are being met properly
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LPA reviewed sign in and out sheets, interviewed staff regarding schedules, and determined facility has been over ratio at least on one occassion (4/29/24).

This poses an immediate health, safety or personal rights risk to 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: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3