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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 033620069
Report Date: 04/06/2022
Date Signed: 04/06/2022 11:00:14 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, 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
01/11/2022 and conducted by Evaluator Aruna Sridharan
COMPLAINT CONTROL NUMBER: 53-CC-20220111122241
FACILITY NAME:GOLD STAR PRESCHOOLFACILITY NUMBER:
033620069
ADMINISTRATOR:LOFFSWOLD, MICHELLEFACILITY TYPE:
850
ADDRESS:335 SOUTH AVENUETELEPHONE:
(209) 256-8059
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY:25CENSUS: 22DATE:
04/06/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michelle LoffswoldTIME COMPLETED:
11:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
License: Facility management retaliated against staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/06/2022 Licensing Program Analyst (LPA) Aruna Sridharan met with director Michelle Loffswold to deliver the findings for the above allegation. During today's inspection LPA observed 22 children and two other staff. It was alleged that the director retaliated against a staff. LPA conducted interviews with licensee and staff. LPA also obtained pertaining documents regarding meetings, text messages and emails. The information obtained revealed inconsistencies. Based on interviews and document review, facility management terminated services for a S1, but inconsistency of information could not prove it was due to retaliation.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Notice of site visit was issued and must remain posted for 30 days. Copy of this report was provided to Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Aruna Sridharan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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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