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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093621202
Report Date: 07/28/2023
Date Signed: 09/21/2023 11:13:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2023 and conducted by Evaluator Soleil Marx
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230727152911
FACILITY NAME:APPLESEEDS ACADEMYFACILITY NUMBER:
093621202
ADMINISTRATOR:BALJIT KAURFACILITY TYPE:
850
ADDRESS:1100 LYONS AVE C1 + C3TELEPHONE:
(530) 208-8216
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96150
CAPACITY:46CENSUS: 27DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Leigh Ellen YarbroughTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff left child on the playground without supervision
INVESTIGATION FINDINGS:
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On July 28th, 2023, Licensing Program Analyst (LPA) Soleil Marx met with Director, Leigh Ellen Yarbrough, for the purpose of conducting a complaint investigation Inspection and to deliver findings. Today's census included 15 preschool age children and 12 school age children above age 6 in care with five staff. It was alleged that staff left a child on the playground without supervision.
Throughout the course of the investigation, LPA conducted interviews, reviewed records, and made observations. Interview revealed inconsistent statements regarding timing and attendance. LPA reviewed records of attendance logs, staff timecards, and surveillance which did not collaborate with the allegation. LPA observed staff using a white board system, name to face checks, and sweeps of the activity space during transition periods. LPA could not prove that staff left a child on the playground without supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
Exit interview was conducted and a copy of this report was given to the Director. Notice of site was given and must remain posted for 30 days. Appeal rights provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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 03-CC-20230727152911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: APPLESEEDS ACADEMY
FACILITY NUMBER: 093621202
VISIT DATE: 07/28/2023
NARRATIVE
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Based on the LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Title 22 are being cited on the attached LIC 9099D and a Civil Penalty in the amount of $500.00 was assessed for absence of supervision.

The director was informed that this report dated 07/28/2023 documents one Type A citation which shall be posted for 30 consecutive days. The director shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



Exit interview was conducted and a copy of this report was given to the Director. Notice of site was given and must remain posted for 30 days. Appeal rights provided.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20230727152911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: APPLESEEDS ACADEMY
FACILITY NUMBER: 093621202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
07/31/2023
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child shall be left without the supervision of a teacher at any time…Supervision shall include visual observation.
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The Director stated staff will attend a training by 07/31/23, regarding supervision,transitions,name to face checks and provide LPA copy of training and a signed attendance list. Each employee will write a summary on what they have learned and submit it to LPA.
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This requirement was not met as evidenced by:
A child was left alone outside without staff supervision for approximately five minutes, which poses a potential Health, Safety, or Personal Rights risk to persons 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: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3