503808634-9-1-2022-04-CC-RVAA-CJ7V7C-20220912161055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 503808634
Report Date: 09/01/2022
Date Signed: 09/01/2022 01:36:18 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, 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
06/13/2022 and conducted by Evaluator Priscilla Zamudio

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20220613140457

FACILITY NAME:	SEQUOIA PRESCHOOL ACADEMY		FACILITY NUMBER:	503808634
ADMINISTRATOR:	GUTHMILLER, JANET		FACILITY TYPE:	850
ADDRESS:	1308 COFFEE ROAD		TELEPHONE:	(209) 526-2273
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY:	30	CENSUS: 14	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jessica Ulloa		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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9

Staff did not provide authorized representative day care child's records upon request.

INVESTIGATION FINDINGS:

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13

On 9/1/22, Licensing Program Analysts (LPAs) Priscilla Zamudio and Stephanie Vega-Gonzalez arrived at the facility to conduct an unannounced complaint inspection. The purpose of the inspection was to deliver investigation findings for the above allegation. LPAs met with Site Supervisor Jessica Ulloa, toured the facility and a census was taken. During the course of this investigation, LPAs reviewed pertinent records and conducted interviews.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency was cited during today's inspection.

An exit interview was conducted with Jessica Ulloa. A copy of this report and Appeal Rights were provided and discussed. A Notice of Site Visit (LIC 9213) form will be posted on the facility's parent's board and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla Zamudio	TELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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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