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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343621219
Report Date: 05/11/2022
Date Signed: 05/11/2022 01:45:59 PM

Substantiated


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
01/31/2022 and conducted by Evaluator Josiah Gathing
COMPLAINT CONTROL NUMBER: 03-CC-20220131080153
FACILITY NAME:KING'S CHILDREN'S ACADEMYFACILITY NUMBER:
343621219
ADMINISTRATOR:KING, JOSETTEFACILITY TYPE:
850
ADDRESS:2635 EDISON AVENUETELEPHONE:
(916) 993-6510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:49CENSUS: 14DATE:
05/11/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff failed to protect child from being hurt by another child
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Josiah Gathing and Karyn Guerra met with Director/Owner Josette King, on May 11, 2022 at approximately 10:30 AM to continue and close the above complaint investigation. The complaint alleged that staff failed to protect a child from being hurt by another child. It was suspected that sufficient supervision was not being provided. Facility records indicated that the incident was witnessed only by a parent and other children present at the time. LPAs learned through interview that there was one teacher (S1) present outside at the time of the incident. It was stated during that time that S1 was speaking with the maintenance person at the facility and was then handed the phone to speak with the facility Director. It was stated that S1 heard a parent honking her car horn in the parking lot. It was stated that the parent approached and claimed that her daughter was being choked by another child. It was stated that S1 did not directly observe the altercation between the children.
Based on interviews with staff and records review the preponderance of evidence standard has been met, and the allegation is substantiated.
CONT. ON 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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 4
Control Number 03-CC-20220131080153
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: KING'S CHILDREN'S ACADEMY
FACILITY NUMBER: 343621219
VISIT DATE: 05/11/2022
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.
LPA discussed this report with facility representative and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/31/2022 and conducted by Evaluator Josiah Gathing
COMPLAINT CONTROL NUMBER: 03-CC-20220131080153

FACILITY NAME:KING'S CHILDREN'S ACADEMYFACILITY NUMBER:
343621219
ADMINISTRATOR:KING, JOSETTEFACILITY TYPE:
850
ADDRESS:2635 EDISON AVENUETELEPHONE:
(916) 993-6510
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:49CENSUS: 14DATE:
05/11/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
01:55 PM
ALLEGATION(S):
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9
Staff used profanity in the presence of daycare children.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Josiah Gathing and Karyn Guerra met with Director/Owner Josette King, on May 11, 2022 at approximately 10:30 AM to continue and close the above complaint investigation. The complaint alleged that an adult providing non-day care services used profanity in front of the children. According to children, staff, and Director interviews, facility personnel do not use profanity in front of the daycare children. Based on the information gathered throughout the course of this investigation there was not sufficient enough evidence nor information to support or dismiss the above allegations. Therefore, the finding for the above allegation was determined to be UNSUBSTANTIATED. An exit interview was conducted in which the report was reviewed and discussed with the Director/Owner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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 4
Control Number 03-CC-20220131080153
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: KING'S CHILDREN'S ACADEMY
FACILITY NUMBER: 343621219
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/12/2022
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Since the incident an additional staff member has been hired. Director will discuss supervision requirements with staff.
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Based on interviews and record review the facility did not comply with the above regulation as there was not direct supervision of the children which poses Health, Safety, or Personal Rights risk to persons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4