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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313623318
Report Date: 12/06/2021
Date Signed: 12/06/2021 11:29:16 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
11/30/2021 and conducted by Evaluator Blake Morillas
COMPLAINT CONTROL NUMBER: 03-CC-20211130084452
FACILITY NAME:LILY PAD EARLY LEARNING CENTER, INC.FACILITY NUMBER:
313623318
ADMINISTRATOR:ZEMLICKA, MICHELLEFACILITY TYPE:
850
ADDRESS:1388 LINCOLN WAYTELEPHONE:
(530) 863-9443
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:33CENSUS: 23DATE:
12/06/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Michelle Zemlicka - DirectorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not report three COVID-19 positive cases to the Department.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On Monday, December 6th, 2021, at 8:47am, Licensing Program Analyst (LPA) made an unannounced visit to the facility and met with the Director, Micelle Zemlicka, in order to initiate the complaint investigation into the above allegations. Upon arrival, 23 preschool children and several staff were observed.
It was alleged that the Facility did not report three Covid-19 positive cases to the Department. When interviewing the Director, it was noted that in the Preschool program, there had been three positive cases of Covid in the past couple of months: one parent and two staff. The director stated that the Covid positive parent had been reported to another LPA, however misunderstood the Covid-19 reporting requirements for licensing regarding the two teachers. Based upon the interview conducted and observations while at the facility, there is not a preponderance of evidence to prove or disprove the allegation did or did not occur, therefore the above allegation is found to be UNSUBSTANTIATED. Even though the allegation is ruled unsubstantiated, a Technical Assistance note (LIC 9102) was given to the Director, reviewing reporting requirements for Licensing. The report was reviewed with the Director and an exit interview was conducted. Notice of site visit to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
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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