<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 550318064
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:31:26 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
08/20/2024 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240820144306
FACILITY NAME:BELLEVIEW SCHOOLFACILITY NUMBER:
550318064
ADMINISTRATOR:KIMBERLY ANGELFACILITY TYPE:
850
ADDRESS:22736 KEWIN MILL ROADTELEPHONE:
(209) 586-5510
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:24CENSUS: 5DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Elisa LuceraTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Criminal Record Clearance-Uncleared adult working in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/29/24, Licensing Program Analyst (LPA) Elvira Sierra conducted a complaint investigation inspection and met with new Site Supervisor, Elisa Lucera. LPA observed two staff members supervising five preschool children.

It was alleged that an uncleared adult is working in the facility. During today’s inspection LPA interview staff and reviewed pertaining documents. Interviews and documents reviewed revealed that staff #1 was present and working in the preschool program since 08/2023. Record reviewed confirmed that Staff #1 was denied criminal record exemption on 03/07/24, therefore individual cannot work or be present in any community care license facility. District Super intendent, Carmel Portillo stated that staff#1 passed District screening requirement and she was unaware of any exemption denial as communication was not sent to her directly to exclude that employee and that she was under the impression employee was under appeal until the decision was final. Based on interviews conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. See attached LIC 9099D page for deficiency cited today under Title 22 Division 12 of the CA Code of Regulations.
Report continues on subsequent page 809C---

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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 4
Control Number 53-CC-20240820144306
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: BELLEVIEW SCHOOL
FACILITY NUMBER: 550318064
VISIT DATE: 08/29/2024
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
An exit interview was conducted in which the report and Appeal of Rights were reviewed and discussed with facility representative, Elisa Lucera. Notice of Site Visit was posted and should remain posted for 30 days. Facility representive acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, facility shall post LIC 809D 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. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A deficiency is cited.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20240820144306
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: BELLEVIEW SCHOOL
FACILITY NUMBER: 550318064
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
101170(e)(1)
1
2
3
4
5
6
7
101170 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department

1
2
3
4
5
6
7
POC; Super intendent stated that facilit ywill exclude the employee from the preschool class until clearance is obtained.
8
9
10
11
12
13
14
This requirement was not met as evidence by; Even though the school has their own clearance process had come to the department knowledge that staff #1 is working in the preschool program and has no criminal record clearance at this time. This is a deficiency that if no corrected poses an immediate risk to the health and safety of the 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.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4