093621202-5-27-2022-03-CC-SDLA-CETNP8-20220527103753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093621202
Report Date: 05/25/2022
Date Signed: 05/27/2022 08:50:12 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
03/02/2022 and conducted by Evaluator Michelle Pascual

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220302142304

FACILITY NAME:	APPLESEEDS ACADEMY		FACILITY NUMBER:	093621202
ADMINISTRATOR:	BALJIT KAUR		FACILITY TYPE:	850
ADDRESS:	1100 LYONS AVENUE		TELEPHONE:	(530) 208-8216
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	46	CENSUS: 12	DATE:	05/25/2022
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Janika Walsh		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Supervision- A daycare child was hit by another daycare child resulting in injury

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Michelle Pascual met with Janika Walsh on March 25th approximately at 11:10am to deliver a complaint finding. LPA observed 12 children in care being supervised by 2 staff.

It was alleged that a daycare child was hit by another child resulting in an injury. LPA Arianna Manabat investigated the complaint through interviews with the Director, staff members, children, parents, and the reporting party. LPA found through staff interviews that there was an ongoing behavioral-action plan implemented for the child. Staff have documented and explained the steps they have taken to mitigate the situation regarding the child as they are concerned for the safety of other children in care. Through record review, LPA Manabat has also found out that the child no longer attends the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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 03-CC-20220302142304

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: APPLESEEDS ACADEMY	FACILITY NUMBER: 093621202
	VISIT DATE: 05/25/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on the information obtained, LPA Manabat was not able to determine that a daycare child was hit by another child resulting in an injury. Therefore, the allegation is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it. An exit interview was conducted.

Notice of site visit and appeal rights were also addressed. The Notice of site visit shall remain posted for 30 days for guardian/parental review.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2