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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313623043
Report Date: 05/05/2022
Date Signed: 05/05/2022 10:01:29 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
04/04/2022 and conducted by Evaluator Jeremey McClain
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220404174359
FACILITY NAME:BUILDING KIDZ SCHOOL - EUREKA (PS)FACILITY NUMBER:
313623043
ADMINISTRATOR:JO ANN FERNANDEZFACILITY TYPE:
850
ADDRESS:1485 EUREKA RD, STE G170TELEPHONE:
(916) 780-5437
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:58CENSUS: 18DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:David TuckerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff inappropriately touched children while in care.
Facility is operating out of ratio.
Staff did not treat child with dignity.
Staff did not properly wear masks.
INVESTIGATION FINDINGS:
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On May 5th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee David Tucker in order to deliver findings of the complaint investigation. to close a complaint investigation. Care and supervision of 18 preschoolers by two staff members was observed. The following was alleged against the facility: staff did not honor the personal rights of children in care by touching a child inappropriately and not treating a child with dignity while in care. It was also alleged that the facility was operating out of ratio and that a positive Covid case at the facility was due to staff inappropriately wearing masks.

During the investigation LPA conducted interviews with staff, children, and parents. LPA reviewed videos from the Bright Wheel application that is used by the facility. LPA also observed staff interaction with children.

The evidence produced from the investigation was insufficient to corroborate the allegations. There is not a preponderance of evidence to prove that the allegations did or did not occur, therefore the allegations were determined to be unsubstantiated. Report Continued on the following page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
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 5
Control Number 03-CC-20220404174359
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: BUILDING KIDZ SCHOOL - EUREKA (PS)
FACILITY NUMBER: 313623043
VISIT DATE: 05/05/2022
NARRATIVE
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There were no Title 22 deficiencies during today’s investigation. LPA reviewed this report with Licensee and provided Appeal Rights. A Notice of Site Visit was provided that must be posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
04/04/2022 and conducted by Evaluator Jeremey McClain
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220404174359

FACILITY NAME:BUILDING KIDZ SCHOOL - EUREKA (PS)FACILITY NUMBER:
313623043
ADMINISTRATOR:JO ANN FERNANDEZFACILITY TYPE:
850
ADDRESS:1485 EUREKA RD, STE G170TELEPHONE:
(916) 780-5437
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:58CENSUS: 18DATE:
05/05/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:David TuckerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility did not provide child's authorized representative complaint documents
INVESTIGATION FINDINGS:
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On May 5th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee David Tucker in order to deliver findings of the complaint investigation. to close a complaint investigation. Care and supervision of 18 preschoolers by two staff members was observed. LPA investigated the allegation that form LIC 9224 (Acknowledgement of Receipt of Licensing Reports) regarding a Type A violation that the facility received in 07/2021. During the investigation, the Licensee stated that there was small percentage of families that had not received and signed LIC 9224. Based on this evidence, the allegation was determined substantiated

Title 22 deficiencies are cited on the subsequent page of this report. Appeal Rights were provided and an exit interview was conducted. A Notice of Site Visit was posted and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 03-CC-20220404174359
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: BUILDING KIDZ SCHOOL - EUREKA (PS)
FACILITY NUMBER: 313623043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2022
Section Cited
HSC
1596.8595(c)(2)
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Reports to be provided to parents or guardian of each child receiving services.(c)(2) Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation that
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Licensee stated that he has went through all the files and identified the families that needed to sign the 9224. Licensee will provide a copy of the report and the 9224 to newly enrolled families up intol 07/26/2022. Licensee will send LPA copies of the signed 9224 for children currently enrolled.
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documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b. This requirement was not met as evidenced by an interview with the licensee on 4/11/2022. Licensee stated that there were still families that had not recieved form LIC 9224 regarding a citation issued on 07/2021. This poses a potential threat to the health and safety of children 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: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5