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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 570305772
Report Date: 07/01/2024
Date Signed: 07/01/2024 10:09:40 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
06/24/2024 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240624152152
FACILITY NAME:ST. PAUL'S LUTHERAN PRESCHOOLFACILITY NUMBER:
570305772
ADMINISTRATOR:JILL HARDINFACILITY TYPE:
850
ADDRESS:625 WEST GIBSON ROADTELEPHONE:
(530) 662-1935
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:46CENSUS: 13DATE:
07/01/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:director, Corrie UptonTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not ensure that children were properly supervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lauren Scott and Licensing Program Manager (LPM) Chayntel Hunter met with Director, Corrie Upton to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPA Scott conducted interviews, and obtained information pertaining to allegation. It was alleged that staff failed to properly supervise children in care.

Based on the interviews, it was revealed there was a lack of supervision and 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 LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
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-20240624152152
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. PAUL'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 570305772
VISIT DATE: 07/01/2024
NARRATIVE
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An exit interview was conducted with the Director. 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 Director, Corrie Upton, that this report dated July 1, 2024 documents one Type A citation Type A citations which shall be posted for 30 consecutive days as there is an immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Scott informed the Director to provide a copy of this licensing report dated, July 1, 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: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240624152152
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. PAUL'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 570305772
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/02/2024
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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Facility changed bathroom supervison policies to include one teacher in the bathroom at all times. Facility will conduct a staff meeting regarding these changes and submit signed meeting notes to LPA by POC date
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Based on interviews, the facility did not comply with the section cited above where children were not properly supervised while in the bathroom, which poses an immediate 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.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3