343602532-10-5-2023-53-CC-KGUA-CWGVN2-20231010163424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343602532
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:03:11 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2023 and conducted by Evaluator Katy Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20230920105534

FACILITY NAME:	FAIRSITE PRESCHOOL		FACILITY NUMBER:	343602532
ADMINISTRATOR:	DUBOIS, KATIE		FACILITY TYPE:	850
ADDRESS:	902 CAROLINE AVENUE		TELEPHONE:	(209) 745-2506
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	144	CENSUS: 94	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kuljeet		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not maintain proper staff-child ratios

INVESTIGATION FINDINGS:

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On 10/05/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced complaint investigation to deliver the findings for the above allegation. LPA met with Program Representative Kuljeet Nijjar (D1). Throughout the course of the investigation, LPA conducted observations, interviews, reviewed and collected documentation. It was alleged that staff members do not maintain proper staff to child ratios. Observations and interviews revealed that the facility has consistently been operating out of ratio in several preschool classrooms.

Based on interviews, file reviews, and observations conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

CONTINUED ON 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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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Control Number 53-CC-20230920105534

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: FAIRSITE PRESCHOOL	FACILITY NUMBER: 343602532
	VISIT DATE: 10/05/2023

NARRATIVE

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A Type-A deficiency was cited on a subsequent 9099-D page. D1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. An exit interview was conducted, and the report was reviewed with D1. LPA provided Licensee Appeal Rights to D1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 53-CC-20230920105534

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: FAIRSITE PRESCHOOL	FACILITY NUMBER: 343602532
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/13/2023 Section Cited CCR 101216.3	1 2 3 4 5 6 7	101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance… This requirement was not met as evidenced by:	1 2 3 4 5 6 7	All preschool staff will sign a statement acknowledging that they have watched the videos titled “Teacher-to-Child Ratios in Child Care Centers” and “Supervising Children in Child Care Centers” available on the CDSS website.
	8 9 10 11 12 13 14	one teacher supervising more than 12 children in attendance based on observation, interview, and record review. The Licensee did not comply with the above regulation which poses an immediate health, safety, and personal rights risk to children in care.	8 9 10 11 12 13 14	LPA will be emailed the statement(s) with all staff signatures by 5 PM on 10/13 /2023. LPA will conduct an unannounced POC visit to clear the deficiency.
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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: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy Velazquez	TELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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