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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364846174
Report Date: 08/31/2023
Date Signed: 08/31/2023 10:59:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2023 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230801081939
FACILITY NAME:FAIRYTALE CASTLE PRESCHOOLFACILITY NUMBER:
364846174
ADMINISTRATOR:WEI ZHAOFACILITY TYPE:
850
ADDRESS:710 EAST FOOTHILL BLVDTELEPHONE:
(626) 567-5678
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:116CENSUS: 41DATE:
08/31/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mary VeraTIME COMPLETED:
11:21 AM
ALLEGATION(S):
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Restrooms unavailable to children
Facility did not report a physical plant issue
INVESTIGATION FINDINGS:
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On 8/30/23 at 9:35 am, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation to deliver final findings. LPA was granted access into the facility and met with Mary Vera. During today’s visit, LPA toured facility and took a census.

Allegations: Restrooms unavailable to children; Facility did not report a physical plant issue

It was alleged the facility had a plumbing problem occur on 07/20/23, children were unable to use the restrooms, and the facility did not report the plumbing problem. LPA interviewed all pertinent parties, including staff and children.


(Cont on 9099C)




Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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 5
Control Number 09-CC-20230801081939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FAIRYTALE CASTLE PRESCHOOL
FACILITY NUMBER: 364846174
VISIT DATE: 08/31/2023
NARRATIVE
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This is an amended C page to reflect change of citation. Staff stated on 07/20/23, at 12:00 pm, there was an issue with plumbing and the water had to be shut off. Staff stated the plumbing problem occurred when most of the children were napping. Staff stated a plumber was called and they arrived at 3:30 pm. LPA reviewed a receipt from the plumber verifying the plumber was at the facility on 7/20/23.

Staff stated if the older children needed to use the restroom, a bucket was available for use. Staff stated the younger children were all placed in pull-ups, even though some of the younger children were potty trained and did not need to wear pull-ups. Staff stated the authorized representatives of the children were not notified of the plumbing problem.

LPA interviewed four children. All the children interviewed did not recall using a bucket to go to the restroom. LPA attempted to interview a younger child and LPA was not able to interview.

LPA interviewed the Licensee and Assistant Director. Both the Licensee and the Assistant Director stated they did not know they had to report the plumbing problem to licensing.

Based on LPA’s video review of the incident and interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. These deficiencies are considered technical violations and no citation is being issued currently.



An exit interview was conducted, a copy of this report was provided to director, appeal rights were discussed.

Notice of Site Visit issued and must be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 09-CC-20230801081939
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: FAIRYTALE CASTLE PRESCHOOL
FACILITY NUMBER: 364846174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
09/05/2023
Section Cited
CCR
101223(a)(2)
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Personal Rights (a) The licensee shall ensure... each child is accorded ...personal rights: (2) To be accorded safe, healthful, ...comfortable...equipment to meet his/her needs.
This requirement was not met as evidenced by
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Assistant Director (AD) stated she will submit a plan regarding regulation 101223 to meet children's needs) for the future and will submit the plan to CCL by 9/5/23.
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Based on interviews conducted and documentation received the facility did not provide a healthful and comfortable restroom evnviroment to meet the child's needs.
This is a potential risk to the health and safety and personal rights of children in care.
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Deficiency Dismissed
Type B
09/05/2023
Section Cited
CCR
101212(d)(1)
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Reporting Requirements
(d) Upon the occurrence, during the operation of the childcare... (d)(1) below, a report shall be made to the ...Department's next working day...
This requirement was not met as evidenced by
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Assistant Director (AD) stated she will fill put the Unusual Incident Report and send to CCL by 9/5/23. AD stated she will send a written statement of acknowledgement, understanding and compliance to regulation 101212 (d) (1) and send written statement to CCL by 9/5/23.
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Based on staff admitting they did not report the incident.

This is a potential risk to the health and safety of 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.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5