393617385-7-21-2021-53-CC-JSMH-C5QVLY-20210809163240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393617385
Report Date: 07/21/2021
Date Signed: 07/21/2021 12:15:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Fabiola Diaz

COMPLAINT CONTROL NUMBER: 53-CC-20210506115500

FACILITY NAME:	ACE TOTS PRESCHOOL		FACILITY NUMBER:	393617385
ADMINISTRATOR:	KHAN, NADIA		FACILITY TYPE:	850
ADDRESS:	7204 SHORELINE DRIVE		TELEPHONE:	(209) 330-1030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	90	CENSUS: 24	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Nadia Khan		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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9

Lack of supervision- Staff failed to adequately supervise daycare child resulting in injuries
Other- Staff terminated services due to retaliation

INVESTIGATION FINDINGS:

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Licensing Program Anlyst (LPA) Fabiola Diaz conducted an inspection with the Site Supervisor, Nadia Khan, to close the investigation alleging the above allegations. During the investigation of this complaint, LPA inspected the facility, interviewed staff, and interviewed parents.
Based on interviews, LPA was informed by staff that staff was in ratio during the incident in which Child 1 (C1) was injured when sliding down a slide, and that staff was circling and supervising the children at the playground. The information obtained during the interviews revealed inconsistencies. Based on interviews and document review, staff terminated services for C1, but inconsistency of information could not prove it was due to retaliation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. Notice of site visit was issued and must remain posted for 30 days. Copy of this report was provided to Licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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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