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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406215976
Report Date: 06/01/2022
Date Signed: 06/01/2022 04:55:32 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/23/2022 and conducted by Evaluator Elvin Baddley
COMPLAINT CONTROL NUMBER: 17-CC-20220523102135
FACILITY NAME:DELMORE FAMILY CHILD CAREFACILITY NUMBER:
406215976
ADMINISTRATOR:LYNSEY DELMOREFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 503-9433
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:14CENSUS: 10DATE:
06/01/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Lynsey DelmoreTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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1. Uncleared Staff had access to day care children
10. Incidents are not being reported
11. Facility's window screen are in disrepair
INVESTIGATION FINDINGS:
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On 6/1/22, at 10:45 AM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced inspection to initiate the investigation of the abovementioned allegations. LPA met with Licensee Lynsey Delmore, and explained the nature of the inspection. At the time of the inspection 10 children are present along with an Assistant (S1).
Upon arriving at 10:45 AM, LPA observed S1 in the front yard of the facility providing supervision to 8 children. At 11:00 AM, LPA reviewed the facility roster with the Licensee and noted S1's name was not on the roster. Licensee informed LPA S1 had began working at the facility one month prior and had not completed the documentation (LIC 508 and LIC 9182) to be associated with the facility. Further, Licensee informed LPA S1 had not been live scanned. LPA asked the Licensee had any other individuals workied at the facility and not be cleared or associated to the Family Child Care Home (FCCH). The Licensee informed LPA S2 had worked at the FCCH prior and had been employed from January to February of 2022. The Licensee was unsure of the exact dates.
(CONT 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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 17-CC-20220523102135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: DELMORE FAMILY CHILD CARE
FACILITY NUMBER: 406215976
VISIT DATE: 06/01/2022
NARRATIVE
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LPA informed LIcensee individuals providing care of children needed to be livescanned, cleared and associated with the FCCH prior to caring for children on grounds.

While discussing the aforementioned with the Licensee in the FCCH living room, LPA observed a bent window screen at 11:00 AM. The bend in the window screen created a gap between the window frame and the screen. LPA informed Licensee the window screen should be in good repair.

LPA discussed incident reporting with the Licensee and the necessity to contact CCLD as well as generate a LIC 624 when an unusual incident occurs. LPA asked Licensee had any unusual incidents occurred on site, specifically COVID related exposures. Licensee informed LPA S3 tested positive for COVID and the FCCH was subsequently closed for a period of time. The Licensee was unsure of the exact date but estimated the positive COVID Exposure occurred six months prior. Licensee was informed the positive exposure would be an incident which should have been reported to CCLD.

Based on LPAs observation and interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulation (CCR) Title 22 Division 12 and CCR 102307(d), CCR 102416.2 (c) (3), 102423 (b) are being cited on the attached LIC 9099 D).

A closing interview was conducted with the Licensee. Licensee was provided and advised of their right to appeal. LPA informed Licensee of the need to provide a plan of correction to CCLD as well as the time which the plan of correction needs to be submitted to CCLD. LIC 9224 was also provided to the Licensee.

The Notice of Site Visit was provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

LPA notes facility inspection occurred from 10:45 AM - 12:00 PM. LPA left site and returned to deliver findings at 4:15 PM

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 17-CC-20220523102135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: DELMORE FAMILY CHILD CARE
FACILITY NUMBER: 406215976
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/02/2022
Section Cited
CCR
102307(d)
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All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met based on
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Licensee to immediately remove unclear individuals form FCCH. Licensee to immediate provide neccessay documents to CCLD to clear and associate individuals with the facility.
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S1 and S2 providing care at the FCCH without livescan clearance. This poses an immediate health, safety risk or personal rights of persons in care.
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(e) Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department. Immediate civil penalty assessed today, $1000.00
Type B
06/08/2022
Section Cited
CCR
102416.2(c)(3)
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In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C), the licensee shall report the following events to the Department...A communicable disease outbreak when determined by the local health authority.
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Licensee to provide CCLD with a written plan on the process which unusual incidents will be reported to the Department by 6/8/22.
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 This requirement was not met based on Licensee failing to report positive COVID Exposure for S3 and a subsequent FCCH closure as the result of the exposure. This poses an potential health, safety risk or personal rights of 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: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 17-CC-20220523102135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: DELMORE FAMILY CHILD CARE
FACILITY NUMBER: 406215976
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2022
Section Cited
CCR
102423(2)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following...To receive safe
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Licensee to repair bent window screen by 6/8/22 and proving photographic proof of correction by 6/8/22.
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 healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met based on LPA observing a bent window screen, causing a gap, in the living room window. This poses an potential health, safety risk or personal rights of 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: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5