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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393617385
Report Date: 01/24/2024
Date Signed: 01/24/2024 11:41:06 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
01/03/2024 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240103162734
FACILITY NAME:ACE TOTS PRESCHOOLFACILITY NUMBER:
393617385
ADMINISTRATOR:KHAN, NADIAFACILITY TYPE:
850
ADDRESS:7204 SHORELINE DRIVETELEPHONE:
(209) 330-1030
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:90CENSUS: 19DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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1. Staff handled day care child in a rough manner causing injury.
INVESTIGATION FINDINGS:
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On January 24th, 2024, at 9:30 AM, Licensing Program Analysts (LPAs) David Nguyen and Lauren Scott conducted a complaint investigation visit and met with Director, Nadia Khan. The purpose of the inspection visit was to deliver the finding for the above allegation. LPA Nguyen disclosed the purpose of the inspection and was granted entrance. LPA Nguyen toured the facility and observed nineteen (19) children being supervised by three (3) adults.

During the course of the investigation, LPA Nguyen conducted interviews with the Director, Teacher, Children, and Parents. In addition, LPA obtained information pertaining to allegation and observed the care and supervision of the daycare children. It was alleged that “Staff handled day care child in a rough manner causing injury.” Interviews conducted revealed that there was time that facility staff handled childcare child in a rough manner causing injury.

----Report continues on subsequent page LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
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 3
Control Number 53-CC-20240103162734
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: ACE TOTS PRESCHOOL
FACILITY NUMBER: 393617385
VISIT DATE: 01/24/2024
NARRATIVE
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Based on the interviews conducted it was determined that the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D page.

Upon receipt of Type A citations, the Director shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.



An exit interview conducted, and report was reviewed with the Director, Nadia Khan. Appeal of Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240103162734
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: ACE TOTS PRESCHOOL
FACILITY NUMBER: 393617385
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/25/2024
Section Cited
CCR
101223(a)(2)
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(a) (2) To be accorded safe, healthful and comfortable accommodations.... to meet his/her needs.

This requirement was not met as evidenced by:
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Staff Meeting will be held to focus on Children’s Personal Rights. Director, Nadia Khan will email LPA the sign-in sheet from this meeting. Director, Khan will create a written statement for staff to sign that describes discipline policy and procedures will be expected of staff for the future.
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Based on interviews conducted, it was revealed that facility staff grabbed the childcare child’s arm, leaving a grab mark and causing pain. This poses an immediate health, safety, or personal rights risk to children in care.
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Director, Nadia Khan will email the signed statements to LPA.
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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: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3