013419452-6-2-2021-52-CC-WNOA-C3ZU3K-20210615151341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013419452
Report Date: 06/02/2021
Date Signed: 06/02/2021 02:52:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2021 and conducted by Evaluator Melanie Otsuji

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20210401135333

FACILITY NAME:	PALM ACADEMY		FACILITY NUMBER:	013419452
ADMINISTRATOR:	YEN NGUYEN		FACILITY TYPE:	850
ADDRESS:	2856 WASHINGTON BLVD.		TELEPHONE:	(510) 979-9794
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	59	CENSUS: 29	DATE:	06/02/2021
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Weiling "Sophie" Ko		TIME COMPLETED:	03:11 PM

ALLEGATION(S):

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- Facility is Operating out of Ratio.
- Staff are not supervising children at all times.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melanie Otsuji and Jonathan Williams arrived to the facility unannounced to conclude investigation into the above allegation(s). LPAs were met by Acting Director Sophie Ko. Present during today's visit were 29 napping preschool aged children and 6 staff members.

During the course of the investigation LPAs conducted interviews, made observations and conducted record reviews. Based on interviews conducted, 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, therefore, the allegation is UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed. An exit interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021

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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