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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619766
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:35:48 PM

Substantiated


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
10/23/2023 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20231023121434
FACILITY NAME:FOLSOM EDUCATIONAL ACADEMYFACILITY NUMBER:
343619766
ADMINISTRATOR:ELSAWAF, FATMAFACILITY TYPE:
850
ADDRESS:381 SOUTH LEXINGTON DR, #100TELEPHONE:
(916) 790-8599
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:27CENSUS: 24DATE:
10/26/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Dr. Fatma EslawafTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff handled day care child in a rough manner.
INVESTIGATION FINDINGS:
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On 10/26/2023, Licensing Program Analysts (LPAs) Soleil Marx and Jennifer Velasco met with the facility representative, Dr. Fatma Elsawaf (FR), to open the complaint investigation and to present findings. LPAs explained the purpose of the inspection. During the investigation, LPAs observed care, obtained and reviewed relevant facility documentation, and conducted interviews. Based on witness statements, a facility staff pulled a child by their legs to move their body. This is a personal rights violation. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED.

One type B Title 22 deficiency is being cited on LIC 9099D.Exit interview was conducted and report was reviewed with Facility Representative, Dr. Fatma Elsawaf. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
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 03-CC-20231023121434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: FOLSOM EDUCATIONAL ACADEMY
FACILITY NUMBER: 343619766
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
101223(a)(1)
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 (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement has not been met.
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Director stated they will provide all preschool staff with personal rights training and will email to LPA the sign-in sheet and the materials used in the personal rights training on or before the POC due date.
jennifer.velasco@dss.ca.gov
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This facility did not meet this requirement as evidenced by multiple witness statements confirming that a staff dragged a child by the legs to reposition the child.
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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: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: 707-953-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
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