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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344500446
Report Date: 05/01/2025
Date Signed: 05/01/2025 01:07:00 PM

Substantiated


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
04/24/2025 and conducted by Evaluator Katy Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20250424130720
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: 27DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michelle RoyTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff handles child in a rough manner.
Staff yells at child.
INVESTIGATION FINDINGS:
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On 05/01/2025, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced complaint investigation and delivered the findings for the above allegations. LPA arrived at the Center and observed a census of 27 preschool aged children being supervised by 5 staff members. LPA accessed Guardian to determine that all required adults were background cleared and associated to the license. LPA met with Director Michelle Roy (D1) and conducted staff and children's interviews.
Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, interviews, reviewed and collected documentation. It was alleged that a staff member handled a child in a rough manner and yelled at a child. Interviews and documentation revealed that on 04/23/2025, a substitute teacher, S1, grabbed a child, C1, by the arm and yelled at C1. The facility reported the incident to Licensing, reported S1 to the substitute agency, and requested that S1 no longer be a substitute at the facility.

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

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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 53-CC-20250424130720
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: 05/01/2025
NARRATIVE
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Based on interviews conducted and documentation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type-A deficiency was cited on a subsequent 9099-D page. D1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D 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. An exit interview was conducted, and the report was reviewed with Director Roy. LPA provided Licensee Appeal Rights to D1. 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: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20250424130720
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2025
Section Cited
CCR
101223(a)(1)
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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidenced by S1 grabbing and yelling at C1 on
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Director Roy (D1) will create a form that all substitutes and new staff will sign, aknowledging childrens' personal rights, before they provide care and or supervision to children. D1 will email LPA the form for review by 5:00 PM on 05/02/2025.
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 04/23/2025. This poses/posed an immediate 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: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3