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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376300213
Report Date: 11/10/2022
Date Signed: 11/10/2022 12:54:41 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
09/27/2022 and conducted by Evaluator Andrea Taylor
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20220927171950
FACILITY NAME:BUDS AND BLOSSOMS PRESCHOOLFACILITY NUMBER:
376300213
ADMINISTRATOR:NIKKI BOLESFACILITY TYPE:
850
ADDRESS:2809 S MISSION RDTELEPHONE:
(760) 645-3044
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:42CENSUS: 11DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nikki Boles-OwnerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal rights a staff threw a child onto the napping mat at nap time.
INVESTIGATION FINDINGS:
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On the date and time listed, Licensing Program Analyst (LPA) Andrea Taylor arrived at the facility for the purpose of delivering the complaint finding regarding the investigation of the above-referenced allegation. September 27, 2022, Community Care Licensing (CCL) received a complaint alleging that a staff member threw a child down on a mat during naptime.
An initial 10-day visit was conducted on October 4, 2022. LPA conducted interviews with staff members, children and LPA obtained pertinent documents/information regarding the investigation. Based on the interviews with staff and children nobody witnessed this staff member or any staff member do anything to any child in care.
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.
In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Andrea Taylor
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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-20220927171950
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: BUDS AND BLOSSOMS PRESCHOOL
FACILITY NUMBER: 376300213
VISIT DATE: 11/10/2022
NARRATIVE
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An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Andrea Taylor
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2