393617385-1-14-2022-53-CC-JLDN-CAST3J-20220118132223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393617385
Report Date: 01/14/2022
Date Signed: 01/14/2022 11:08:45 AM

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
10/19/2021 and conducted by Evaluator Stacey Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20211019103438

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: 14	DATE:	01/14/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Nadia Khan		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Care and Supervision : Child was left unsupervised

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of delivering complaint findings regarding the allegation listed above. LPA met with Facility Representative. LPA observed fourteen children supervised by two staff.

It was alleged that children are left unsupervised in the facility. The facility was inspected and interviews were conducted with the reporting party, facility staff, and parents. On October 27, 2021, during the initial complaint inspection, LPA observed children in preschool room #1 left unsupervised while staff transitioned children to the outside front door of the facility to meet their parent. There was not a clear view of all parameters for room #1. Director informed LPA the facility had staffing issues that day, therefore she needed cover both the front desk and room#1. Based on the observation, preponderance of evidence has been met. The allegation is determined to be substantiated.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

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 4

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
10/19/2021 and conducted by Evaluator Stacey Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20211019103438

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: 14	DATE:	01/14/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Nadia Kahn		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights: Staff hit daycare child

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licesning Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of delivering complaint findings regarding the allegation listed above. LPA met with Facility Representative. LPA observed fourteen children supervised by two staff.

It was alleged that staff hit daycare child. The facility was inspected and interviews were conducted with the reporting party, facility staff, and parents. Staff denied hitting child#1 and reported that thery were removed from the playground structure as safety precaution. Staff reported that child was exhibiting unsafe behavior while on the playground structure. Based on the information received, the allegation is determined to be unsubstantiated. 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.

An exit interview was conducted and a Notice of Site Visit and appeal rights were provided to Facility Representative, Nadia Khan.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 53-CC-20211019103438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ACE TOTS PRESCHOOL	FACILITY NUMBER: 393617385
	VISIT DATE: 01/14/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Title 22 Deficiency has been cited on the attached LIC 9099D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 9099D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, acknowledging receipt of Licensing Reports LIC 9099D in each child's files.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left Facility Representative, Nadia Khan whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided and shall remain posted for 30 days .

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 53-CC-20211019103438

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ACE TOTS PRESCHOOL	FACILITY NUMBER: 393617385
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/17/2022 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).	1 2 3 4 5 6 7	Director stated she has increased staffing for the facility. With the addition to staffing, Director is now able to solely monitor the front desk. Director will discuss supervision requirements during the next staff meeting that is scheduled for 1/21/22. Director will submit staffing schedule and staff agenda to CCL by POC date- 1/17/22.
	8 9 10 11 12 13 14	Supervision shall include visual observation. This requirement was not met as evidenced by: LPA observed on 10/27/21, staff left children unsupervised in preschool room#1. There was no additional staff in room #1 to provide care and supervision to children. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4