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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153808628
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:03:47 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2021 and conducted by Evaluator Peter Espinoza
COMPLAINT CONTROL NUMBER: 04-CC-20210818125225
FACILITY NAME:SOUTH FORK PRESCHOOL & CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808628
ADMINISTRATOR:VILLANI, KIMFACILITY TYPE:
850
ADDRESS:6401 FAY RANCH ROADTELEPHONE:
(760) 378-2570
CITY:WELDONSTATE: CAZIP CODE:
93283
CAPACITY:32CENSUS: 14DATE:
08/24/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christi Zuber, TeacherTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
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9

Staff and children are not required to wear a mask
INVESTIGATION FINDINGS:
1
2
3
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5
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9
10
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12
13
On 08/24/2021, Licensing Program Analyst (LPA) Pete Espinoza arrived at the facility unannounced to initiate/complete the investigation into the above allegation. Information was gathered to investigate the above allegation. LPA met with Christi Zuber, Teacher and Kim Vallani, Superintendent. and toured the facility. LPA explained the reason for this inspection with Director and census was taken. LPA interviewed Superintendent and School Nurse.

Based upon observations and information gathered through interviews, this agency has investigated the complaint alleging Staff and children are not required to wear a mask. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegations are UNSUBSTANTIATED.
An exit interview was conducted with Kim Vallani, Superintendent and appeal rights were explained. A printed copy of the report as well as a printed copy of appeal rights was provided at the conclusion of the visit.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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