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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 214005495
Report Date: 12/18/2020
Date Signed: 12/18/2020 12:00:27 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2020 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20201013104647
FACILITY NAME:ALPHA KIDS ACADEMY LLCFACILITY NUMBER:
214005495
ADMINISTRATOR:LOPEZ, STEPHANIEFACILITY TYPE:
850
ADDRESS:1461 SOUTH NOVATO BLVDTELEPHONE:
(415) 408-3645
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:30CENSUS: 7DATE:
12/18/2020
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Magda BachakashviliTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Personal Rights: Teacher made the child wear underwear at the daycare.
INVESTIGATION FINDINGS:
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On 12/18/2020 at 11:30AM., Licensing Program Analyst (LPA) Haydee Caliboso conducted a closing complaint investigation in response to the above allegation. LPA met with the Director Magda Bachakashvili. Present during the tele-inspection were 7 children and 3 Teachers.

Based on LPA's tele-inspection and information gathered through interviews which were conducted, and record review. The child was humiliated when the staff made the child wear an underwear. The preponderance of evidence standard has been met. The above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22,Division 12 & Chapter 1, are being cited on the attached LIC 9099D.

An exit interivew was conducted appeal right were discussed, and a copy was provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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 05-CC-20201013104647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALPHA KIDS ACADEMY LLC
FACILITY NUMBER: 214005495
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/08/2021
Section Cited
CCR
101223(a)(3)
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 Personal Rights: 101223(a)(3)
The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidence by:
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Licensee shall ensure children's personal rights are met daily. Such as physical, and social emotional well-being. Licensee and staff shall ensure children's authorized representative are informed should their child needs appropriate and extra clothings at school. Licensee will provide training to staff how to handle and support children when accident occur at school. LPA instructed the Licensee to submit a written plan by 01/8/21 prevent the situation from happening again.

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Based on LPA's interviews, information gathered, and record review, Director confirmed C1 did not have extra clean clothing and pants when the accident occurred. Director stated that they could have called the parents to inform them about the accident because the family of C1 lives a few houses away from the school.C1 felt humiliated, embarrassed, and made fun of by peers. Therefore, the above allegations posses a potential Health and Safety risk to children 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.
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2020 and conducted by Evaluator Haydee R Caliboso
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20201013104647

FACILITY NAME:ALPHA KIDS ACADEMY LLCFACILITY NUMBER:
214005495
ADMINISTRATOR:LOPEZ, STEPHANIEFACILITY TYPE:
850
ADDRESS:1461 SOUTH NOVATO BLVDTELEPHONE:
(415) 408-3645
CITY:NOVATOSTATE: CAZIP CODE:
94947
CAPACITY:30CENSUS: 7DATE:
12/18/2020
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Magda BachakashviliTIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
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3
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5
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9
Personal Rights: Teacher does not help children with toileting.
Personal Rights: Teacher made inappropriate comments to children.
INVESTIGATION FINDINGS:
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On 12/18/20/20 at 1:50 PM., Licensing Program Analyst (LPA) Haydee Caliboso conducted a closing complaint investigation in response to the above allegation. LPA met with the Director Magda Bachakashvili. Present during the tele-inspection were 7 children and 3 Teachers.

Staff confirmed that they help children with toileting and used appropriate language when speaking to children.

Based on LPA's tele-inspection and information gathered through interviews which were conducted, and record review, the agency has invesitigated the complaint allegations above. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, appeal rights were discussed, and a copy was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Haydee R CalibosoTELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3