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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343602581
Report Date: 07/26/2024
Date Signed: 07/26/2024 02:29:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2024 and conducted by Evaluator Loraine Perez
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240719122719
FACILITY NAME:ANTELOPE CHRISTIAN ACADEMY PRESCHOOLFACILITY NUMBER:
343602581
ADMINISTRATOR:CAROLYN HEWETTFACILITY TYPE:
850
ADDRESS:4533 ANTELOPE ROADTELEPHONE:
(916) 722-6169
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:90CENSUS: 7DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cheryl RamirezTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff not doing fire drills
Staff not keeping accurate records
INVESTIGATION FINDINGS:
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Licensing Program Analysts Loraine Perez and Erwina Pascual-Golamco (LPAs) met with current Director Cheryl Ramirez for the purpose of opening and closing a complaint investigation of the above allegations. The purpose of today's inspection was explained.

It was alleged that facility staff not doing fire drills and staff not keeping accurate records. Throughout the course of investigation, LPAs conducted inspections and observations, and interviewed staff. LPA observed the facility's fire drill log but no documentation to date. LPA reviewed staff files and observed that staff files were incomplete. Based on LPA inspection, observation, interviews, and record review the preponderance of evidence standard has been met, therefore the above allegations are SUBSTANTIATED.

Title 22 deficiencies are cited on the following LIC9099-D. Exit interview conducted and report was reviewed with Director. A notice of site visit was given and must remain posted for 30 days. Appeals right provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
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 03-CC-20240719122719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ANTELOPE CHRISTIAN ACADEMY PRESCHOOL
FACILITY NUMBER: 343602581
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2024
Section Cited
CCR
101174(d)(2)
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101174(d) Disaster drills shall be conducted at least every six months. …
(2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.
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Director stated they will conduct a fire drill on Monday 7/29/24 and will document it on the fire drill log. Fire drills will be conducted monthly and will ensure it is documented moving forward. LPA will conduct a POC.
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This requirement was not met as evidenced by:
LPA observed the facility's fire drill log but no documentation to date.
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Type B
08/12/2024
Section Cited
CCR
101217(a)
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101217(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: …

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Director stated that she will work together with the adminitrative assistant to comlplete the staff files by 5pm on POC due date. LPA will conduct a POC.
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This requirement was not met as evidenced by:
LPA reviewed staff files and observed that staff files were incomplete.
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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: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3