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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845484
Report Date: 02/04/2022
Date Signed: 02/04/2022 06:20:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/20/2021 and conducted by Evaluator Susan Brewer
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20211220084655
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
334845484
ADMINISTRATOR:LEWIS, AMANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 784-9335
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:14CENSUS: 12DATE:
02/04/2022
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Qualifed Assistant TIME COMPLETED:
06:30 PM
ALLEGATION(S):
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Facility failed to provide a safe environment
INVESTIGATION FINDINGS:
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On the above date and time, Licensing Program Analysts (LPAs) Susan Brewer and Joanne Domingo, arrived unannounced at the facility to conclude a complaint investigation and deliver findings. The LPAs were greeted by Licensee Staff Marissa Santillan, conducted a COVID-19 Pre-screening and granted entry into the facility. Present were the 1 staff and Licensees's Spouse. A census was taken of 12 childen in care.

It was alleged that the facility failed to provide a safe environment for children in care.

On 12/22/2022 LPAs S. Brewer and J. Domingo, conducted an 10-day initial investigation for the above allegation and needed more time to complete the investigation. During the inspection LPAs reviewed staff and children's files, obtained records, made observations, conducted interviews with pertinent parties.
During today's investigation additional interviews were conducted with relevant parties, staff and children's records were reviewed and observations made through a tour of the facility inside and out.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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 5
Control Number 10-CC-20211220084655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
VISIT DATE: 02/04/2022
NARRATIVE
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Regarding the allegation that the Facility failed to provide a safe environment:
On 12/22/2022 at approximately 2:33 PM, LPA Joanne Domingo, conducted a census of 18 children and Staff 1 on LIC811 present in the outdoor activity area. A trampoline was observed with a day care child in it at the time of the inspection. A review of children's records on 12/22/2022 revealed that 5 of the 18 children in care were infants under 2 years of age and was determined to be out of ratio and over capacity. The facility was found to be in violation and Two citations issued on a separate report. See LIC809D recorded on 12/22/2022.

At approximately 3:55 PM during a file review of staff files, records showed that Staff 3 (S3 on the LIC811 Confidential Names List) was hired in July 2021, and began employment and working directly with day care children at the facility from August 2021, as an uncleared adult. The licensee Amanda Lewis, confirmed by by her own admission that in July 2021, S3 was hired as an employee and worked until 12/17/2021. The department conducted a background check on 12/21/2021 which confirmed that S3 began a background check on 08/01/2022 but did not complete the process or obtain clearance from the Care Provider Management Bureau (CPMB), to work at the Lewis Family Child Care Home.

At 4:01 PM during an inspection of the 2nd Floor of the home Lead by the Licensee Amanda Lewis, LPA Susan Brewer observed a portable propane gas grill "coco flame" with a round tin filled with ashes, set on the bathroom vanity shelf. LPA observed 2 cans of tobacco, a long hooka pipe rope and a various glass pipes, with peripherals in a metal case and storage bin. The licensee stated they do not smoke and it was hooka, non-nicotine tobacco. Photos taken of the ingredients in the on canned product possessed by the licensee Amanda Lewis, to smoke was a nicotine product. LPAs clothing, hair and face coverings carried the smell of smoke.

On 12/22/2022 at approximately 4:04 PM, LPA S.Brewer, began the inspection downstairs. LPA S. Brewer, observed 6 play pens set up as cribs, one pen observed with a pillow, 1 cot and a infant swing with a blanket in the downstairs bedroom used for napping. No children were observed to be napping in the room at the time. On 02/04/2022 LPAs observed 5 play pens set up, 1 infant still sleeping in a play pen with loose blankets. LPAs conducted a records check and determined that the sleep logs were not up to date for the 4 infants care. 2 of 4 infants logs were not present and 2 of 4 infant logs had not been completed since February 2, 2022. The napping room was pitch black with loud sound napping music that would not allow the LPAs observation of sight or vision to monitor a infant child/children for potential labored breathing.
Continued on LIC9099C page 2
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 10-CC-20211220084655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2022
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health & Safety ยง1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a CA clearance or a criminal record exemption as required...
This requirement was not met as evidenced by:
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On 12/22/2022, The licensee Amanda Lewis, stated the uncleared adult/employee has not returned to work after 12/17/2022 and is no longer employeed at the facility and the violation has been corrected. LPAs verifed on 02/04/2022 during the inspection. staff marissa Santillan signed on behalf of the licensee
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Based on staff records reviewed the Licensee Amanda Lewis, failed to obtain a criminal record clearance or exemption for a previous employee prior to working at the facility from approximately 08/01/2021 through 12/17/2021, which poses an immediate risk to the Health and Safety of Children in Care.
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The licensee Amanda Lewis, will submit a statement of understanding the regulation to have all adult residents, employees and volunteers complete a full Criminal Record Clearance, prior to working with daycare children on or before 02/07/2022, by mail, fax or e-mail to Community Cae Licensing.
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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: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20211220084655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2022
Section Cited
CCR
102424(a)
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102424 Smoking Prohibition
(a) Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a).

This requirement was not met as evidenced by:
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On 02/04/2022 Licensee's Spouse Matthew Lewis, provided a tour and verified that the Hooka pipe, hooka products to smoke and peripherals were removed from the home, therefore the violation was corrected. Staff Marissa Santillan signed on behalf of the licnesee.
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During a facility inspection on 12/22/2022 LPA Susan Brewer, observed a hooka grill, glass pipes, peripherals & nicotine tobacco, posessed by Licensee Amanda Lewis, and exited the facility with the smell of smoke in clothing & hair, which poses a potential risk to the Health & Safety of the children in care.
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Type B
02/04/2022
Section Cited
CCR
102417(d)
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102417(d) The home shall provide safe toys, play equipment and materials.

This requiement was not met as evidenced by:
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02/04/202 the Licensee's Spouse Matthew Lewis, removed the ladder from the trampoline and closed the protective netting and corrected the voilation in the presence of the LPA. Staff Marissa Santillan signed on behalf of the licnesee.
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Interviews conducted revealed that two children have fallen out of a trampoline, 02/04/2022 LPA Susan Brewer, observed 2 daycare children under 2 years of age climbing a trampoline ladder without support while another child sat on the base, which poses a potential risk to the health & safety of children.
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The licensee will follow-up with a written statement of understanding that the trampoline and all play equipement will be used according to manufacturers guidelines, direct supervision as well as removing climbing structures for the trampoline when not in use to the department on or before 02/15/2022, by mail or e-mail.
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: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 10-CC-20211220084655
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 334845484
VISIT DATE: 02/04/2022
NARRATIVE
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Continued from LIC9099C:

During on 12/22/2022 LPAs observed a daycare child in trampoline located in the outdoor play area. Interviews conducted on 02/04/2022 revealed that a daycare child and/or children have fallen out of the trampoline while in care, where the licensee and staff allow more than one daycare children to jump in the trampoline at the same time, which is a potential risk to the Health and Safety of the children in care.

At approximately 2:55 PM LPA Susan Brewer, observed children under two yeas of age climbing the ladder to the trampoline without support while a Third daycare child sat along the perimeter base of the trampoline outside of the netting which daycare staff were with other children across the yard. The licensee's Spouse removed third child and the ladder in the LPAs presence.

Based on the interviews conducted, the documentation obtained and observations by the department, the allegation: The Facility failed to provide a safe environment is SUBSTANTIATED. The preponderance of evidence standard has been met.

See LIC 9099D for Type A Citation cited for 102370(d)(1) Criminal Record Clearance



See LIC 9099D for Type B Citation cited for 102424(a) Smoking Prohibition and 102417(d) The home shall provide safe toys, play equipment and materials.

A Civil Penalty has been assessed on this visit. Payment is due when billed and the check(s) or money orders shall be made payable to "California Department of Social Services". YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

A Notice of Site Visit and Type A Deficiencies from today's visit must be posted for 30 days. Failure to keep these postred for the entire 30 days will result in an immediate $100.00 civil Penalty for each.

An exit interview was conducted, Appeal Rights were reviewed and a copy of this report and LIC9224 was provided with the Licensee staff Marissa Santillan, at the facility.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5