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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343614395
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:01:07 PM

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
08/09/2023 and conducted by Evaluator Josiah Gathing
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230809092755
FACILITY NAME:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343614395
ADMINISTRATOR:CHRISTINA DIAZ BUSHMANFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 487-4647
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:22CENSUS: 13DATE:
09/06/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Christina Diaz-BushmanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff not following day care child's dietary restrictions.
INVESTIGATION FINDINGS:
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On Wednesday, September 6, 2023, at approximately 2:00 PM Licensing Program Analyst (LPA) Josiah Gathing met with Director Christina Diaz-Bushman, for the purpose of a complaint investigation and to deliver findings. It was alleged that staff was not following day care child's dietary restrictions. Throughout the course of the investigation, LPA conducted interviews, reviewed documents, and made observations. LPA observed allergies documented in childs folders and posted in the facility. Staff interviews revealed that all food restrictions and allergies are documented at the time of enrollment and staff keeps up to date with postings. Parent interviews did not reveal any evidence to support the allegation.
Although the alleged violation may have happened or is valid, the preponderance of evidence standard has not been met to fully prove or disprove that they did or did not occur, therefore, they are unsubstantiated. An exit interview was conducted and a notice of site visit provided. Notice of site visit shall remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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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