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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073407418
Report Date: 05/03/2023
Date Signed: 05/03/2023 05:00:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2023 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20230427101056
FACILITY NAME:PANACHE ENFANTSFACILITY NUMBER:
073407418
ADMINISTRATOR:HOGUE, ALYSSAFACILITY TYPE:
850
ADDRESS:2410 SAN RAMON VALLEY BLVD#100TELEPHONE:
(925) 549-2239
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:60CENSUS: 32DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Stefanie GalvezTIME COMPLETED:
04:44 PM
ALLEGATION(S):
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Staff files are incomplete
INVESTIGATION FINDINGS:
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On 5/3/2023 at 9:37am Licensing Program Analyst (LPA) Morgan Pringle met with Incoming Director, Stefanie Galvez for a Initial 10-Day Complaint visit to investigate a complaint that was filed against the facility alleging staff files were incomplete. Facility is dual licensed and holds a license for infants (073407419). Present during the visit were thirty-two (32) preschool age children and four (4) teachers.

Through record review it was found that three (3) of the four (4) staff present had incomplete files. LPA determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D. Failure to submit Proof of Corrections (POC) by Plan of Correction date may result in civil penalties.

A notice of site visit was given to licensee and must be posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with Stefanie Galvez.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 52-CC-20230427101056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PANACHE ENFANTS
FACILITY NUMBER: 073407418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
101216(g)(1)
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(g) All personnel...shall be in good health...(1)... good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
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Director and incoming Director will make sure to obtain LIC503 Health Screening Report from all 3 teachers, and verification of a tuberculosis test for S1 and S2. Director will submit documents and a statement to LPA Pringle, by POC date, explaining how the facility will ensure staff files are complete at all times.
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This requirement was not met as evidenced by: S1, S2 and S3 did not have a Health Screening Report on file and S1 and S2 were missing proof of tuberculosis test. This poses a potential risk to the health and safety of the children in care.
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Type B
05/12/2023
Section Cited
HSC
1596.7995(a)(1)
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(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles...
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Director and incoming Director will make sure to obtain immunization records for S1 and S3. Director will submit statement to LPA Pringle, by POC date, explaining how the facility will ensure completed staff files moving forward. Director will also submit completed immunization records to LPA Pringle.
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This requirement was not met as evidenced by: S3 is missing immunization record for Measles and S1 is missing immunization record for measles and pertussis. This poses a potential risk to the health and safety of the 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: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3