330901543-9-30-2025-10-CC-DMUN-DMFL6G-20251014082841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330901543
Report Date: 09/30/2025
Date Signed: 09/30/2025 10:58:27 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2025 and conducted by Evaluator Tricia Danielson

COMPLAINT CONTROL NUMBER: 10-CC-20250924151816

FACILITY NAME:	ANNE SULLIVAN PRESCHOOL AND KINDERGARTEN		FACILITY NUMBER:	330901543
ADMINISTRATOR:	ALICIA BEATRIZ VAI		FACILITY TYPE:	850
ADDRESS:	21776 PALOMAR ST.		TELEPHONE:	(951) 678-3557
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	116	CENSUS: 67	DATE:	09/30/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alicia Vai, Educational Director		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff does not provide adequate supervision resulting in day care child sustaining an injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Alicia Vai, Educational Director and explained the purpose of the visit.
Regarding the allegation "Staff does not provide adequate supervision resulting in day care child sustaining an injury", it was alleged that the school did not provide adequate supervision for the children during outdoor play while on the playground which resulted in Child #1 (C1) sustaining an injury. Interviews were conducted with three (3) staff which revealed at the time of the incident, thirteen (13) children were playing on the playground in the presence of two (2) staff which meets required staffing ratios. A review of attendance records and staff time sheets verified this information. C1 was unable to be interviewed and Child #2 (C2) (CONTINUED ON LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

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 10-CC-20250924151816

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ANNE SULLIVAN PRESCHOOL AND KINDERGARTEN	FACILITY NUMBER: 330901543
	VISIT DATE: 09/30/2025

NARRATIVE

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(CONTINUED FROM LIC 9099-C)
who was also involved in the incident, declined to speak with LPA. LPA inspected the immediate and surrounding areas where the incident occurred as well as the actual tricycle involved and found no concerns or defective equipment.
Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and this report was reviewed with and provided to Director Vai along with Appeal Rights. An LIC 9213- Notice of Site Visit was also provided and must remain posted near the main entrance for 30 days. Non-compliance with posting will result in a $100 fine. This report must be accessible to the public for three years.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025

LIC9099 (FAS) - (06/04)

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