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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624247
Report Date: 11/26/2024
Date Signed: 11/26/2024 02:17:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
10/23/2024 and conducted by Evaluator Soleil Marx
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20241023101753
FACILITY NAME:EXCELSIOR PRESCHOOL GOLD RIVER LLCFACILITY NUMBER:
343624247
ADMINISTRATOR:FUGATE, NANCYFACILITY TYPE:
850
ADDRESS:2317 GOLD MEADOW WAYTELEPHONE:
(916) 730-8757
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:118CENSUS: 25DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Michelle IngramTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility operating out of ratio due to lack of staff.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Soleil Marx and Erwina Pascual-Golamco, met with Director, Michelle Ingram, for the purpose of delivering findings to a complaint investigation alleging that the facility is operating out of ratio. Throughout the course of the investigation, LPA conducted interviews, reviewed records, and made observations. It was determined by interview of staff and authorized representatives, that the facility was operating out of ratio on at least one occasion due to staff changes and sickness. Statements revealed the facility was out of ratio in the morning of Tuesday 10/24/2024, while awaiting substitutes to arrive. Based on interview, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED. One type A Title 22 deficiency was cited on 9099-D.Facility Representative was informed that this report dated 11/26/2024 documents a Type A citation which shall be posted for 30 days. A copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report A signed Acknowledgement of Receipt of Licensing Report(LIC 9224),or other written statement, must be placed in the child's file for verification.Exit interview conducted and report reviewed with Director. Appeal rights were provided. A notice of site visit was given and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 3
Control Number 03-CC-20241023101753
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: EXCELSIOR PRESCHOOL GOLD RIVER LLC
FACILITY NUMBER: 343624247
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
101216.3(a)
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101216.3 Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.
This requirement was not met as evidenced by:
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Director stated ratio requirements have been met by increased staffing since the ratio incident on 10/24/24. LPAs observed facility operating within ratio requriements. LPAs will clear defeciency.
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Based on interview, the facility did not comply by the section cited above by operating out of ratio on at least one occasion on 10/24/24, which poses an immediate Health, Safety, or Personal Rights risk to persons in care
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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: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 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
10/23/2024 and conducted by Evaluator Soleil Marx
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20241023101753

FACILITY NAME:EXCELSIOR PRESCHOOL GOLD RIVER LLCFACILITY NUMBER:
343624247
ADMINISTRATOR:FUGATE, NANCYFACILITY TYPE:
850
ADDRESS:2317 GOLD MEADOW WAYTELEPHONE:
(916) 730-8757
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:118CENSUS: 25DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Michelle IngramTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Children are not provided adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Soleil Marx and Erwina Pascual-Golamco, met with Director,Michelle Ingram, for the purpose of delivering findings to a complaint investigation alleging that children are not provided adequate food service. Throughout the course of the investigation, LPA made observations, reviewed records, and conducted interviews. LPA observed the kitchen to be fully stocked with food and drinks. LPA observed food in kitchen aligned with the posted menu. LPA observed children being served an adequate amount of food. LPA observed records of meals being documented in parent communication app. Interviews with staff did not reveal concerns regarding food service. Interviews with authorized representatives did not provide proof that children were not provided adequate food service. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is unsubstantiated. No Title 22 deficiencies were issued as a result of the investigation. Exit interview conducted and report reviewed with Director. A Notice of Site Visit was provided that must be posted for 30 days. Appeal Rights provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3