Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313616885
Report Date: 06/07/2019
Date Signed: 06/07/2019 11:23:19 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2019 and conducted by Evaluator Jeremey McClain
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190514165702
FACILITY NAME:GAN YELADIM JEWISH PRESCHOOLFACILITY NUMBER:
313616885
ADMINISTRATOR:KORIK, MALKAFACILITY TYPE:
850
ADDRESS:4410 DOUGLAS BLVD.TELEPHONE:
(916) 500-4522
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:30CENSUS: 5DATE:
06/07/2019
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Malkie KorikTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Lack of supervision resulting in a child sustaining a fractured collar bone.

Facility staff failed to notify the child's authorized representative of an injury sustained while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jeremey McClain met with Director Malkie Korik to close a complaint investigation. Upon arrival, LPA observed five preschool children supervised by one teacher. It was alleged that a lack of supervision resulted in a serious injury of child in care, and that the facility failed to report the injury to the parents of the child. During the investigation, LPA conducted interviews, made observations at the facility, and reviewed documents related to the incident. Based on the evidence that was gathered, LPA determined that there is not enough evidence to conclude the allegations are true. There was conflicting evidence to determine whether the child was injured at the facility or not. The preponderance of evidence standard has not been met, therefore, the allegations are determined to be unsubstantiated.
There were no Title 22 deficiencies during today’s investigation. LPA reviewed this report with Director and provided a Notice of Site Visit that must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019
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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