343602581-12-7-2023-03-CC-ABLI-CYQVX9-20231221154909

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343602581
Report Date: 12/07/2023
Date Signed: 12/07/2023 09:50:36 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
10/18/2023 and conducted by Evaluator Gagandeep Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20231018162139

FACILITY NAME:	ANTELOPE CHRISTIAN ACADEMY PRESCHOOL		FACILITY NUMBER:	343602581
ADMINISTRATOR:	CAROLYN HEWETT		FACILITY TYPE:	850
ADDRESS:	4533 ANTELOPE ROAD		TELEPHONE:	(916) 722-6169
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	90	CENSUS: 17	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Pastor Avelina Salino Jr.		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff is operating beyond terms and conditions of the license.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gagandeep Singh met with the facility representative, Pastor Avelina Salino Jr., to deliver the findings of the complaint investigation for above allegation.

During the investigation, LPA inspected the facility, interviewed the facility staff and reviewed the facility records. Based on inspection and interviews, it was found that the facility is using three rooms for the child care and one room for the elementary school education. Based on record review, it was found that the facility only have 27 children enrolled. It was found that three classroom, being used for day care, have sufficient amount of space for the children enrolled. LPA suggested the facility to make the decision about decreasing the maximum capacity of the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Copy of this report was reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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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