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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344500446
Report Date: 09/10/2024
Date Signed: 09/10/2024 10:50:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
08/21/2024 and conducted by Evaluator Katy Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240821085623
FACILITY NAME:FORTUNE PRESCHOOLFACILITY NUMBER:
344500446
ADMINISTRATOR:MICHELLE ROYFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BOULEVARDTELEPHONE:
(916) 793-3671
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:84CENSUS: 18DATE:
09/10/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Michelle RoyTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Day care child sustained injury due to staff neglect
Staff did not ensure playground is not in disrepair
INVESTIGATION FINDINGS:
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On 09/10/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced field visit to deliver the findings for the above allegations. LPA arrived at the facility and was met by Director Michelle Roy (D1). LPA disclosed the purpose of the inspection and was granted entrance. LPA observed a census of 18 preschool aged children being supervised by 6 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.
Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, interviews, and reviewed and collected documentation. LPA reviewed the facility’s file. It was alleged that a day-care child sustained an injury due to staff neglect. Interviews with the child and staff did not reveal corroboration for the allegation. The child was supervised but fell and recieved an injury. It was alleged that staff did not ensure the playground was not in desrepair. The playground was newly constructed and there was no disrepiar.

CONTINUED ON 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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 2
Control Number 53-CC-20240821085623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: FORTUNE PRESCHOOL
FACILITY NUMBER: 344500446
VISIT DATE: 09/10/2024
NARRATIVE
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Based on interviews and observations, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is UNSUBSTANTIATED. In the areas that were evaluated on 09/10/2024, no deficiencies were cited during today's inspection. An exit interview was conducted with Director Roy and Appeal Rights were provided by LPA. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2