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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 243808724
Report Date: 02/20/2024
Date Signed: 02/21/2024 04:11:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2023 and conducted by Evaluator Ka Vang
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20231206132853
FACILITY NAME:BUHACH PRESCHOOLFACILITY NUMBER:
243808724
ADMINISTRATOR:GAMA, JUANFACILITY TYPE:
850
ADDRESS:2606 N. BUHACH ROADTELEPHONE:
(209) 489-2008
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:89CENSUS: DATE:
02/20/2024
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not report incident to childrens' authorized representatives
INVESTIGATION FINDINGS:
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On 02/21/2024, Licensing Program Analyst (LPA) Ka Vang and Licensing Program Manager (LPM) Cynthia Brannon arrived at the facility to conduct an unannounced follow-up inspection to deliver the findings of the complaint investigation that was initiated on 12/12/2023. LPA met with Site Supervisor Andrea Ceja Martinez. An inspection tour of the facility was conducted, and census was taken. LPA explained and discussed the allegations and the amended findings with Licensee and Site Supervisor.

During the course of the investigation, LPA conducted class observation, record reviewed, and interviews. During the interviews, it was disclosed that a staff member observed an incident involving a child conducted inappropriate behaviors; however, the staff member failed to report the incident to the site supervisor and or the child’s parent(s)/authorized representative.

Based on the interviews and information attained during the investigation, there is preponderance evidence indicated that the staff did not report the incident to the children’s authorized representative. Based on the above information, the allegation is SUBSTANTIATED.

(Continued on LIC809-C).


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
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 04-CC-20231206132853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BUHACH PRESCHOOL
FACILITY NUMBER: 243808724
VISIT DATE: 02/20/2024
NARRATIVE
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Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiency is being cited during this inspection. See attached LIC 9099D.

Site Supervisor Andrea Ceja Martinez was provided a copy of appeal rights. A notice of site visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Andrea Ceja Martinez.

Note: This is an amended report.
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 04-CC-20231206132853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BUHACH PRESCHOOL
FACILITY NUMBER: 243808724
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2024
Section Cited
CCR
101216(k)
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 Personnel Requirements: (k) The licensee or designated individual shall instruct all personnel to report observations or evidence of violations of any of the personal rights specified in Section 101223.

This requirement was not met as evidenced by:
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Per Site Supervisor, she will work with licensee to ensure that all staff at the facility complete the training of reporting personnel requirements and licensing reporting requirement. Site Supervisor agrees to submit proof of documentation of training including, training materials, attendees and date of training conducted to Licensing Office-Fresno by 02/29/2024.
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During the interviews, it was disclosed that a staff member observed an incident involving a child conducted inappropriate behaviors, but the staff member failed to report the incident to the facility designated individual.
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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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Ka Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3