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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013419452
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:59:02 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, 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
09/07/2022 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220907150419
FACILITY NAME:PALM ACADEMYFACILITY NUMBER:
013419452
ADMINISTRATOR:BLAS, CHANTELFACILITY TYPE:
850
ADDRESS:2856 WASHINGTON BLVD.TELEPHONE:
(510) 979-9794
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:59CENSUS: 25DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ruth YongTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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- Qualifications. Day care does not have a director.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct an initial investigation into the above allegation. LPA was met with Licensee, Ruth Yong. Present during today's visit were 4 preschool staff and 25 preschool aged children.

LPA conducted interviews and LPA was informed by Ms. Ruth Yong that the although Director on file was Ms. Sheila Ledesma and is qualified she has not been acting as the Director of the preschool program (see attached 9099D for citation). Based on LPA observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC. 9099D.

Exit interview conducted. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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 2
Control Number 52-CC-20220907150419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PALM ACADEMY
FACILITY NUMBER: 013419452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2022
Section Cited
CCR
101215.1(b)
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Title 22, Division 12 Chapter 1 Article 06 Continuing Requirements Section 101215.1 Child Care Center Directors Qualifications and Duties (b) All child care centers shall have a director.
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Licensee is to provide LPA with the name of newly assigned Director within 10 business days (by 9/22/22). A complete Director packet is to be provided to LPA within 30 days (by 10/8/2022).
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This requirement is not been met as evidence by: Based on the LPA record review and staff interviews, the facility does not have a current Qualified Director. This poses a potential health & safety risk to children in care.
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Licensee is to also provide Director job duty statement and a signed written statement that Director will follow all written duties as shown.
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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: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2