573622547-4-8-2025-53-CC-BENN-DFMRY9-20250411132555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 573622547
Report Date: 04/08/2025
Date Signed: 04/08/2025 11:15:20 AM

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
02/14/2025 and conducted by Evaluator Erwin Tjhia

COMPLAINT CONTROL NUMBER: 53-CC-20250214141426

FACILITY NAME:	ACADEMY 4 KIDS		FACILITY NUMBER:	573622547
ADMINISTRATOR:	BARRAGAN, PATRICIA & BARRA		FACILITY TYPE:	830
ADDRESS:	2455 WEST CAPITOL AVE, #110		TELEPHONE:	(916) 389-0843
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY:	12	CENSUS: 12	DATE:	04/08/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Patricia Barragan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Day care child was provided food they are allergic to resulting in a reaction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erwin Tjhia met with Director, Patricia Barragan, to deliver findings of the complaint investigation regarding the above allegation. LPA observed 12 children supervised by 4 staff.

It was alleged that Day care child was provided food they are allergic to resulting in allergic reaction. Throughout the course of the investigation, LPA conducted interviews with director and staff. The interview revealed that staff were aware of the child allergic to beans and served different type of food to the child. However, staff failed to prevent the child from reaching out other child’s food that contained beans, which caused an allergic reaction.

Based on the information obtained during the investigation the evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. The following Title 22 Deficiency is/are being cited on the subsequent 9099-D page. Upon receipt of Type A citations, Director shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.

Appeal Rights were provided, and LPA posted a Notice of Site Visit which must remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 53-CC-20250214141426

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: ACADEMY 4 KIDS	FACILITY NUMBER: 573622547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/08/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/09/2025 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: 2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.	1 2 3 4 5 6 7	1. Staff held a training regarding food allergies, food preparation, and supervision. 2. The program shall submit to LPA a written plan outlining the procedures they put in place and what was discussed during the staff training. The written plan shall be sent to LPA by close of business 04/09/2025 to clear the deficiency.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: a child, who is allergic to beans, grabbed food containing beans from another child’s plate during lunch time, causing a severe allergic reaction. Staff were aware of the child's food allergies and needs; however, they failed to prevent the child from reaching out other child’s food (beans). This is an immediate health and safety risk to 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: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
02/14/2025 and conducted by Evaluator Erwin Tjhia

COMPLAINT CONTROL NUMBER: 53-CC-20250214141426

FACILITY NAME:	ACADEMY 4 KIDS		FACILITY NUMBER:	573622547
ADMINISTRATOR:	BARRAGAN, PATRICIA & BARRA		FACILITY TYPE:	830
ADDRESS:	2455 WEST CAPITOL AVE, #110		TELEPHONE:	(916) 389-0843
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY:	12	CENSUS: 12	DATE:	04/08/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Patricia Barragan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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9

Facility staff did not react appropriately to child's allergic reaction

INVESTIGATION FINDINGS:

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3
4
5
6
7
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12
13

Licensing Program Analyst (LPA) Erwin Tjhia met with Director, Patricia Barragan to deliver findings of the complaint investigation regarding the above allegation. LPA observed 12 children supervised by 4 staff.

It was alleged that Facility staff did not react appropriately to a child's allergic reaction. Throughout the course of the investigation, LPA interviewed director and staff and conducted record review. The interviews revealed that staff attempted to administer an EpiPen when the child was having an allergic reaction. The interview also revealed that staff proceeded to call paramedics when noticing the child was not getting better. It was later determined that the EpiPen initially administered by staff, which was in the child’s EpiPen package, was a sample used for training.

Based on the information obtained throughout the course of this investigation the above allegations, LPA Tjhia determined that the allegations were found to be UNSUBSTANTIATED, meaning although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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

LIC9099 (FAS) - (06/04)

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