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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622005
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:15:58 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
10/27/2022 and conducted by Evaluator Karyn Guerra
COMPLAINT CONTROL NUMBER: 03-CC-20221027113930
FACILITY NAME:APPLE A DAY PRESCHOOL & INFANTS CTR (INF)FACILITY NUMBER:
343622005
ADMINISTRATOR:FARFAN, LILIYAFACILITY TYPE:
830
ADDRESS:5013 EL CAMINO AVENUETELEPHONE:
(916) 481-5400
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:18CENSUS: 7DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Michelle IngramTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Uncleared adult(s) have access to day care children.
INVESTIGATION FINDINGS:
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At 8:50 a.m. on Wednesday, November 2nd, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Michelle Ingram, for the purpose of an unannounced complaint inspection. It was alleged that uncleared adult(s) have access to day care children. A census was conducted upon arrival and 7 infants were observed with 3 staff. Staff Laura Scott and Child Care Careers substitute staff, Wijdan Alsubaihawi, did not have a criminal record clearance associated to the facility. This poses an immediate risk to the health and safety of children in care. Civil penalties were assessed. The Director stated that they recently started employment at the facility and did not know that the substitute was not associated to the facility. LPA did not observe either staff associated to the facility roster. Transfer request documents for both individuals were completed during inspection. LPA advised director to always get documentation of clearances. The preponderance of evidence standard has been met, and the allegation is substantiated.

report continued on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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-20221027113930
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: APPLE A DAY PRESCHOOL & INFANTS CTR (INF)
FACILITY NUMBER: 343622005
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2022
Section Cited
CCR
101170(e)(2)
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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:...(2) Request a transfer of a criminal record clearance as specified in Section 101170(f).. This requirement was not met, as evidenced by:
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LPA collected documents for criminal record clearance transfer request during today's inspection. Director was advised to maintain written documentation of clearances and associations.
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Based on interview and file review, 2 staff in the infant room (Wijdan Alsubaihawi, Laura Scott) were not associated to the facility.
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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: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20221027113930
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: APPLE A DAY PRESCHOOL & INFANTS CTR (INF)
FACILITY NUMBER: 343622005
VISIT DATE: 11/02/2022
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 809D 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 for parental review.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4