093621202-11-4-2022-03-CC-NDUY-CKXTYU-20221107140915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 093621202
Report Date: 11/04/2022
Date Signed: 11/04/2022 12:07:36 PM

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
08/12/2022 and conducted by Evaluator Karyn Guerra

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220812104441

FACILITY NAME:	APPLESEEDS ACADEMY		FACILITY NUMBER:	093621202
ADMINISTRATOR:	BALJIT KAUR		FACILITY TYPE:	850
ADDRESS:	1100LYONS AVENUE C3		TELEPHONE:	(530) 208-8216
CITY:	SOUTH LAKE TAHOE	STATE: CA	ZIP CODE:	96150
CAPACITY:	46	CENSUS: 11	DATE:	11/04/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jennifer Martinez		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not adequately supervise children in care

Staff did not inform child's authorized representative of injury

INVESTIGATION FINDINGS:

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At 10:30 a.m. on Friday, November 4th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Staff, Jennifer Martinez, for the purpose of an unannounced complaint inspection. Director, Kalei Walsh, was not present at the facility. Upon arrival, LPA observed a census of 11 children supervised by 2 staff. During today's inspection, LPA conducted interviews and delivered findings. It was alleged that staff did not adequately supervise children in care and that staff did not inform child's authorized representative of injury. Throughout the course of the investigation, LPA conducted interviews, obtained documentation, and made observations. LPA came to learn of an incident concerning an unexplained bite that was observed on a child. An unusual incident report was received by the department. Conflicting information was received on whether or not the injury occurred at the facility. Through interviews with staff and parents, LPA came to learn that

Report continued on 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

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 03-CC-20220812104441

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: 11/04/2022

NARRATIVE

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general injury reporting practices are to call or text parents, and follow up with an injury report. Interviews with parents did not reveal any supervision or communication concerns. The allegations are unsubstantiated. Although the alleged violations may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that they did or did not occur, therefore, they are unsubstantiated. An exit interview was conducted with Staff, Jennifer Martinez. A notice of site visit was provided and shall remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC9099 (FAS) - (06/04)

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