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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330901543
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:24:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2022 and conducted by Evaluator Alaina Wilburn
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20220914153209
FACILITY NAME:ANNE SULLIVAN PRESCHOOL AND KINDERGARTENFACILITY NUMBER:
330901543
ADMINISTRATOR:MARGARITA BLATMANFACILITY TYPE:
850
ADDRESS:21776 PALOMAR ST.TELEPHONE:
(951) 678-3557
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:116CENSUS: 70DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Diana Autumn, Asst. DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff inappropriately touched a day care child
INVESTIGATION FINDINGS:
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At 11:30AM on October 26, 2022, Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced complaint visit. LPA met with Assistant Director Diana Autumn, to deliver findings on the above stated allegation. During today's visit, LPA interviewed Staff #3 (S3). The investigation consisted of child record review and interviews with staff, children and a potential witness.

On 09/14/2022, a complaint allegation was received by the Community Care Licensing (CCL) office that facility staff inappropriately touched a day care child. During interviews, Staff deny observing or participating in any questionable activity with Child #1 (C1) or any of the children. Staff advised C1 is fully potty trained and does not require assistance with toileting. Staff advised for children who are potty trained, they usually only need assistance with buttoning, snapping, and zipping their clothing. The children interviewed, did not corroborate allegation, or report any inappropriate behavior with staff assisting in the restroom. LPA was unable to interview C1 as parent declined the request.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 10-CC-20220914153209
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: ANNE SULLIVAN PRESCHOOL AND KINDERGARTEN
FACILITY NUMBER: 330901543
VISIT DATE: 10/26/2022
NARRATIVE
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Based on record review, interviews and observation conducted, the allegation that facility staff inappropriately touched a day care child, may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report along with the appeal rights were provided to Assistant Director Diana Autumn.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2