Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566202639
Report Date: 02/15/2019
Date Signed 02/15/2019 12:37:09 PM


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
11/21/2018 and conducted by Evaluator Ana Tolentino
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20181121110050
FACILITY NAME:WEISS FCC AKA ROBIN'S NESTFACILITY NUMBER:
566202639
ADMINISTRATOR:WEISS, ROBIN IRENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 388-0150
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:14CENSUS: 4DATE:
02/15/2019
UNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Robin Weiss and Tristin ElizaldeTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Record Keeping- Licensee did not provide Type A deficiency reports.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Tolentino made an unannounced visit to conclude a Complaint Investigation and met with Licensee Ms. Robin Weiss and Assistant Tristin Elizalde. The purpose of the visit was discussed, and a tour of the facility was conducted.
Complaint received alleged " Licensee did not provide Type A deficiency reports."

On August 1, 2018, Licensee was cited 102423(a)(4) Personal Rights, child sustained injury while in care. On August 17, 2018, Licensee attended an Informal Conference at the Santa Barbara Regional Office to discuss the deficiency cited August 1, 2018. AB633-Child Care Parent Notification Requirements requires the Licensee provides to parents/guardian’s copies of any licensing report that documents a Type A citation and any licensing documents pertaining to a conference conducted by the licensing agency.

LPA reviewed children records and found seven files did not have the Acknowledgement of Receipt of Licensing Reports (LIC9224) documenting the Licensing Reports of 8/1/2018 and 8/17/18 as required.

Today, a Type B deficiency is being cited under Title 22 Division 12, see 9099-D. Appeal rights provided

LPA observed licensee post the Notice of Site visit.
Substantiated
Estimated Days of Completion: 86
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ana TolentinoTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2019
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 17-CC-20181121110050
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: WEISS FCC AKA ROBIN'S NEST
FACILITY NUMBER: 566202639
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2019
Section Cited
HSC
1596.8595(c)
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A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
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Licensee shall provide copies to all parents with the 8/1/18 and 8/17/18 reports. Licensee must have all parents sign the Acknowledge of Receipt of Licensing Reports for and keep a copy in the child's file for 12 months (LIC9224),
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LPA reviewed children records and found seven files did not have the Acknowledge of Receipt of Licensing Reports form (LIC9224) on file.
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Today 2/15/2019 upon arrival LPA was provided a Licensing folder with all licensing records. This included the Licensee providing all the parents copies of reports with the
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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: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ana TolentinoTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2019
LIC9099 (FAS) - (06/04)
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