013420570-4-22-2022-52-CC-WNOA-CDXNMV-20220429103544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013420570
Report Date: 04/22/2022
Date Signed: 04/22/2022 12:52:27 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/03/2022 and conducted by Evaluator Melanie Otsuji

COMPLAINT CONTROL NUMBER: 52-CC-20220203084458

FACILITY NAME:	PALM ACADEMY		FACILITY NUMBER:	013420570
ADMINISTRATOR:	YEN NGUYEN		FACILITY TYPE:	830
ADDRESS:	2856 WASHINGTON BLVD		TELEPHONE:	(510) 979-9794
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	12	CENSUS: 5	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Ruth Yong		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Administrator did not allow child to return to school after quarantining for COVID.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to complete investigation into the above allegation. LPA met with Owner/Administrator, Ruth Yong. Also present during today's visit were 5 infant aged children and 3 staff members.

During the course of the investigation LPA conducted interviews and record review. Based on interviews conducted, it was confirmed that facility failed to allow a child to return to campus due to not following the campus' covid protocols which included signing a letter which states "Suppose a classroom must be shut down due to COVID-19 exposure due to you knowingly violating the above policy resulting in your child testing positive for COVID-19. In that case, you could be liable to pay up to two weeks of collective tuition for the classroom." Based on LPAs observations and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code 1596.80 is being cited on the attached LIC. 9099D. An exit interview was conducted with Administrator, Ruth Yong.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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 2

Control Number 52-CC-20220203084458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PALM ACADEMY	FACILITY NUMBER: 013420570
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/13/2022 Section Cited CCR 101223(a)(1)	1 2 3 4 5 6 7	Personal Rights. (a)(1) To be accorded dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	Facility is to train staff on the importance of ensuring children's personal rights are not violated. All staff that work with the infant program, including Administrator, shall watch the Children's Personal Rights in Child Care video found at: ccld.childcarevideos.org. Documentation showing signature of individual and date video viewed to be submitted to LPA
	8 9 10 11 12 13 14	- This requirement is not being met as evidence by: Facility failed to allow a child to return to the facility due to not signing a letter stating parents will be held liable for 2 weeks of tuition for the entire class should their child have COVID and the classroom has to shut down. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14	no later than 5/13/2022 via email.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2