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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 511374283
Report Date: 01/08/2024
Date Signed: 01/08/2024 08:53:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Bianca Mendez
COMPLAINT CONTROL NUMBER: 13-CC-20230919091853
FACILITY NAME:KING AVENUE STATE PRESCHOOLFACILITY NUMBER:
511374283
ADMINISTRATOR:CHAVEZ, MARIA CARMENFACILITY TYPE:
850
ADDRESS:630 KING AVENUETELEPHONE:
(530) 822-5019
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:24CENSUS: 20DATE:
01/08/2024
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Carmen ChavezTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Child sustained an unexplained bruise while in care.
INVESTIGATION FINDINGS:
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On 1/8/24 at 8:20am, Licensing Program Analyst (LPA) Mendez conducted an unannounced complaint inspection, and met with director Carmen Chavez. It was alleged that child sustained an unexplained bruise while in care.

LPA Mendez interviewed director on 9/22/23 at 10:05am and director stated there have been no recent injuries at the facility and when an injury occurs, they create an ouch report, parents will receive a copy of the report, a copy stays in the child's file and another copy goes to the main office.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
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 2
Control Number 13-CC-20230919091853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KING AVENUE STATE PRESCHOOL
FACILITY NUMBER: 511374283
VISIT DATE: 01/08/2024
NARRATIVE
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LPA interviewed staff (S1-S2) on 9/22/23 and addressed the following allegation that child sustained an unexplained bruise while in care. S1 stated that C1 is constantly watched and stated that P1 was concerned over a visible red mark on C1’s arm. S1 stated as soon as an incident happens then they will write up an incident report and document when it happens, where it happened and explain how it happened and what they did to care for it or clean it if its a cut or scrape. When the parent comes in for pick then they will explain and sign off the incident report. S2 that no children have experienced any injuries. S2 stated that P1 had informed them that C1 had a red mark on their arm. S2 stated that C1 did not get the mark on their arm from school. S2 stated that the teacher usually completes the ouch report.

LPA interviewed parent (P1) on 9/21/23 and stated they noticed the bruise on C1’s left arm on 9/15/23 when P1 picked C1 from day-care. P1 stated that C1 attends King Ave Preschool part time from 8am-11am and then goes to daycare from 11:30am-4:30pm after preschool.

LPA interviewed children C1-C9 on 9/22/23 and 10/16/23, LPA was only able to interview 8 of 9 children. 8 of 8 children stated that they received a band aid when they get hurt. 4 of 8 children stated that they have witnessed their friends get hurt while playing outside.

During today’s visit facility was toured. LPA observed 20 children in care and 3 staff, facility was operating within the ratio.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. An exit interview was conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2