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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503808634
Report Date: 11/27/2023
Date Signed: 11/27/2023 02:12:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2023 and conducted by Evaluator Valerie Mireles
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20231122084617
FACILITY NAME:SEQUOIA PRESCHOOL ACADEMYFACILITY NUMBER:
503808634
ADMINISTRATOR:GUTHMILLER, JANETFACILITY TYPE:
850
ADDRESS:1308 COFFEE ROADTELEPHONE:
(209) 526-2273
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:30CENSUS: 16DATE:
11/27/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janet GuthmillerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Personnel documents are falsified.
INVESTIGATION FINDINGS:
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On 11/27/2023, Licensing Program Analyst (LPA) Valerie Mireles conducted an unannounced complaint inspection to open and provide findings for the above allegation. LPA met with Director, Janet Guthmiller. LPA explained the allegations, a census was taken where LPA observed 16 preschool children in care supervised by the Director and two staff. LPA toured the facility, inside and outside. During today’s visit, LPA also conducted an interview with the Director, reviewed staff files and took photos.

This agency investigated the complaint alleging that personnel documents are falsified. During the investigation of the staff file review, LPA visually observed a duplicate of Staff #5's immunization record in Staff #4’s file. Staff #4 did not have a copy of their own immunization record in the file. LPA interviewed Director who indicated that she was not aware and that it may have been misfiled due to staff having same last names. This violates Record Keeping for the Community Care Licensing. Therefore, the allegation that personnel records are falsified is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
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 04-CC-20231122084617
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: SEQUOIA PRESCHOOL ACADEMY
FACILITY NUMBER: 503808634
VISIT DATE: 11/27/2023
NARRATIVE
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Per California Code of Regulations, Title 22, Division 12, Chapter 1, this deficiency is cited on the attached LIC 9099D.

An exit interview conducted with Director, Janet Guthmiller. A copy of this report and Appeal Rights were provided and discussed.

A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 04-CC-20231122084617
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SEQUOIA PRESCHOOL ACADEMY
FACILITY NUMBER: 503808634
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2023
Section Cited
HSC
1596.7995
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Employees or volunteers at day care center; immunization requirements; records: A person shall not be employed ... at a day care center if he/ she has not been immunized against influenza, pertussis, and measles.
This requirement was not met as evidenced by LPA’s observation:
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Director will obtain current immunization records for Staff #4 and provide proof by 12/11/2023.
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Based on LPA's visual observation of staff files, a duplicate copy of Staff #5's immunization record was in Staff #4's file. This poses a potential risk to the Health, Safety and Personal Rights to children in care.
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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.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Valerie Mireles
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3