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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 290310484
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:10:08 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
09/19/2022 and conducted by Evaluator Fabiola Diaz
COMPLAINT CONTROL NUMBER: 03-CC-20220919085818
FACILITY NAME:KINDERLAND PRESCHOOLFACILITY NUMBER:
290310484
ADMINISTRATOR:PETERSON, LUPEFACILITY TYPE:
850
ADDRESS:12914 COLFAX HWYTELEPHONE:
(530) 273-5255
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:60CENSUS: 18DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Dodie MenetTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Adult at the facility made an inappropriate request of day care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fabiola Diaz arrived at the facility at approximately 10:05 am and met with Program Specialist Dodie Menet to close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed 18 day care preschool children. During the investigation LPA Diaz made observations, conducted interviews, and gathered documents pertaining to the investigation. It was alleged an adult at the facility made an inappropriate request to day care child. Staff interviews and children interviews did not disclose information nor concerns about the above allegation. 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.
An Exit Interview was conducted in which the report was reviewed and discussed with Dodie. A copy of this report was provided to Dodie. A Notice of Site Visit and Appeal Rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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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