543801735-10-12-2022-57-CC-SFAG-CLFVZV-20221123155319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 543801735
Report Date: 10/12/2022
Date Signed: 10/12/2022 03:10:36 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 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
10/05/2022 and conducted by Evaluator Ruby Ocegueda

PUBLIC

COMPLAINT CONTROL NUMBER: 57-CC-20221005163023

FACILITY NAME:	GOLDEN VALLEY PRESCHOOL		FACILITY NUMBER:	543801735
ADMINISTRATOR:	TREVINO, LETICIA		FACILITY TYPE:	850
ADDRESS:	12623 AVENUE 416		TELEPHONE:	(559) 528-6949
CITY:	OROSI	STATE: CA	ZIP CODE:	93647
CAPACITY:	48	CENSUS: 34	DATE:	10/12/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Leticia Trevino		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not maintaining confidentiality of child's records

INVESTIGATION FINDINGS:

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On 10/12/2022, Licensing Program Analyst (LPA) Ruby Ocegueda conducted a 10 day unannounced complaint inspection at the facility. LPA Ocegueda met with Preschool Facilitator Vidala Gallegos and Expanded Learning Administrator Jayboy Camaquin. LPA explained the reason for the inspection and discussed the allegation at hand. A tour of the facility was conducted and a census was taken.

During the course of the investigation, LPA Ocegueda, reviewed and collected facility records and conducted interviews of the reporting party (RP) and staff. Regarding the allegation indicating “staff are not maintaining confidentiality of child's records”, it was determined that the facility could not find a physician’s record that was provided to the facility sometime after June 2022. Report continued to 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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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Control Number 57-CC-20221005163023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOLDEN VALLEY PRESCHOOL	FACILITY NUMBER: 543801735
	VISIT DATE: 10/12/2022

NARRATIVE

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Continued from previous 9099 page

It is unclear what the date of the original physician’s report had. There was an updated physicians report dated for 9/08/2022 but in interviewing staff #1, he/she could not locate the expired physical that was submitted in June and stated he/she did not know where the expired physicians report was at this time, thus unable to ensure the expired physicians report was currently being kept confidential or safe guarded as required. All other pertinent records for child #1 and his/her family were present in the file today. A copy of the regulations related to children’s records was provided to staff #1.

This agency investigated the complaint alleging that “staff are not maintaining confidentiality of child's records”, and has determined that the complaint allegations were SUBSTANTIATED, meaning the preponderance of evidence standard has been met.

An exit interview was conducted with Preschool Facilitator Vidala Gallegos.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiency was cited: (see 9099-D). Appeal Rights were provided today. Notice of Site Visit LIC 9213 must be posted for 30 days.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 57-CC-20221005163023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOLDEN VALLEY PRESCHOOL	FACILITY NUMBER: 543801735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/26/2022 Section Cited CCR 1011221(c)(1)	1 2 3 4 5 6 7	Child's Records (c)All information and records obtained from or regarding children shall be confidential. (1)The licensee shall be responsible for safeguarding the confidentiality of record contents. Based on record review and interview, the licensee did not meet the requirement stated above.	1 2 3 4 5 6 7	Today, Preschool Facilitator Gallegos stated they currently have a more efficient plan to collect documents. Mrs. Gallegos stated that the facility will submit their plan of how documents are collected, safeguarded and kept confidential. A written plan will be submitted to the Department by POC date 10/26/2022.
	8 9 10 11 12 13 14	It was determined that a physician's report that was submitted after 6/2022 could not be located today thus the facility could not confirm that the document was safeguarded or being kept confidential as required. This poses a potential health, safety, and or personal rights risks to 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: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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