364846174-11-3-2022-09-CC-AROS-CN32UU-20230113164254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364846174
Report Date: 11/03/2022
Date Signed: 11/03/2022 05:25:40 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, 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
10/18/2022 and conducted by Evaluator Blanca Ruiz-Silva

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20221018150153

FACILITY NAME:	FAIRYTALE CASTLE PRESCHOOL		FACILITY NUMBER:	364846174
ADMINISTRATOR:	ROSA LOPEZ		FACILITY TYPE:	850
ADDRESS:	710 EAST FOOTHILL BLVD		TELEPHONE:	(626) 567-5678
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	116	CENSUS: 55	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Director Laura Perez and Administrator Wei Zhao		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Hazardous items are accessible to children in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Blanca Ruiz and Elyse Jones arrived at the facility to discuss and deliver findings of an investigation for the above allegation. LPA met with Acting Director, Laura Perez at the time of the inspection and stated the purpose of the investigation. This inspection was conducted in Chinese/Mandarin with the assistance of Translator DSS/CCL 16374 . LPAs toured the center and a census were taken. A 10 day inspection was initiated by LPA Ruiz on 10/20/2022. The following was discussed with administrator:
During the process of the investigation, records were reviewed, and interviews were conducted with pertinent parties. It was reported that hazardous items are accessible to children in care. Upon arrival to the facility, LPAs conducted a physical inspection of the facility. In Classroom N.2, LPAs observed Staff N.1 and Staff N.2 providing care and supervision to 12 children in care. Children were eating snacks and walking around the room when LPAs observed Staff N.1 's purse open and accessible to children in the room with prescription medication which present an immediate risk to the Health and Safety of the children in care.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 09-CC-20221018150153

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: 11/03/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In addition, on Classroom N.5 LPAs observed the following items accessible to the children in the bottom shelf: Hand Sanitizer Spray, Shaving Cream and Air Wick Spray all items have labels specifying "keep out of reach of children and pets, extremely flammable. Harmful or fatal if swallowed, eye irritant, harmful if directly inhaled. This product may cause allergic reactions …" Discussion regarding additional storage for staff at the facility was initiated with facility director and administrator.

Based on LPAs observation, it was confirmed that the facility was out of compliance. Therefore the preponderance of evidence standard has been met, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, divisions & chapter number are being cited on the attached LIC 9099D.)

Upon receipt, licensee shall post 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 for the next 12 months.

The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

An exit interview was conducted, Notice of Site Visit posted, appeal rights discussed and given to the Site Director, Laura Perez along with a copy of this report and a LIC 9224 form.

A copy of this report was provided to the licensee on this date. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC FOR THREE YEARS.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 09-CC-20221018150153

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: 11/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/04/2022 Section Cited CCR 101238(g)	1 2 3 4 5 6 7	Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement was not met as evidenced by: Upon arrival to the facility, LPAs conducted a physical inspection of the facility. In Classroom N.2, LPAs observed Staff N.1 and Staff N.2 providing care and supervision to 12 children in care.	1 2 3 4 5 6 7	Facility director removed all items from Classroom N.2 and Classroom N.5 within this inspection. A written agreement plan must be submitted to CCL by COB 11/04/22. Director/Administrator agrees to provide a plan to have staff items ( which includes medication) inaccessible to children in care.
	8 9 10 11 12 13 14	Children were eating snacks and walking around the room when LPAs observed Staff N.1 's purse open and accessible to children in the room with prescription medication.This poses an immediate risk to the health and safety for children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5