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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623896
Report Date: 03/28/2024
Date Signed: 04/08/2024 09:27:27 AM

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
03/27/2024 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20240327154703
FACILITY NAME:DISCOVERY TREE SCHOOL - CAPITAL CITYFACILITY NUMBER:
343623896
ADMINISTRATOR:ABIGAIL NEWBERRYFACILITY TYPE:
850
ADDRESS:744 P STREETTELEPHONE:
(916) 965-3661
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:58CENSUS: 19DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Abigail Newberry-NorviseTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Lack of supervision resulting in inappropriate behavior among children.
INVESTIGATION FINDINGS:
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This is an amend report on April 8, 2024 at 8:50a.m.

On March 28th, 2024, at 9:00 a.m., Licensing Program Analyst (LPA) Pa Dao Vang met with Director Abigail Newberry-Norvise to conducted an unannounced inspection and to follow up on the complaint report and self-reported Unusual Incident submitted to the Regional Office on 3/27/2024. There were 18 preschool children supervised by 3 staff.

During today's inspection, LPA conducted interviews, and made observations. LPA learned on 3/26/2024 during an afternoon outside activity, when S1 stepped away from the left side of the yard to assist with C3 on the right side of the yard.
Continue Report on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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-20240327154703
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: DISCOVERY TREE SCHOOL - CAPITAL CITY
FACILITY NUMBER: 343623896
VISIT DATE: 03/28/2024
NARRATIVE
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C1 took C2 behind the play structure (between the left side of the play structure facing the sandbox) and took both their shirts off. C2 ran around to S1, as S1 addressed the incident immediately outside. LPA learned there was a lack of supervision, when S1 stepped away to assist with C3 on the right side of the yard and left the children on the left side of the yard unsupervised for the moment. The parents were notified by S1 on the same day.

LPA Vang informed Director Abigail Newberry- Norvise that this report dated 3/28/2024, documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care. Also, LPA informed Director to provide a copy of this licensing report dated 3/28/2024, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Abigail Newberry- Norvise. Additionally, appeal rights were provided.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20240327154703
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: DISCOVERY TREE SCHOOL - CAPITAL CITY
FACILITY NUMBER: 343623896
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/29/2024
Section Cited
CCR
101229(a)(1)
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101229 (a)(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
This requirement is not met as evidenced by:
Based on interviews and the self-reported unusual incident report,
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Director talked to the staff about proper supervision, and postioning self outside to cover all blind spots. Director will conduct a staff training and meeting on 4/5/2024. Director will email LPA an agenda with staff's signatures.
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S1 stepped away to assist C3 leaving the left side of the yard unsupervised. C1 took C2 behind the play structure & took off both their shirts (facing the left side of the yard with no supervision). The lack of supervion is a potential health, safety, and/or personal rights risk to children 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: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
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