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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364846174
Report Date: 05/02/2024
Date Signed: 05/02/2024 10:49:55 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2024 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240405083750
FACILITY NAME:FAIRYTALE CASTLE PRESCHOOLFACILITY NUMBER:
364846174
ADMINISTRATOR:FENG XUEFACILITY TYPE:
850
ADDRESS:710 EAST FOOTHILL BLVDTELEPHONE:
(626) 567-5678
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:116CENSUS: 9DATE:
05/02/2024
UNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Zhuoluan Ma-AKA MiaTIME COMPLETED:
11:11 AM
ALLEGATION(S):
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Staff did not comply with terms and conditions set forth in the admission agreement
INVESTIGATION FINDINGS:
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On 5/2/24 at 8:17 am, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation to deliver final findings. LPA met with Mia Zhuoluan and was granted access into the facility. LPA toured facility and took a census.

Allegation: Staff did not comply with terms and conditions set forth in the admission agreement

On 04/05/24, a complaint was received alleging authorized representatives were not informed of a rate increase at least 30-calendar-days prior to. LPA interviewed all pertinent parties, including staff, and reviewed files.


(Cont on 809C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
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 2
Control Number 09-CC-20240405083750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FAIRYTALE CASTLE PRESCHOOL
FACILITY NUMBER: 364846174
VISIT DATE: 05/02/2024
NARRATIVE
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Staff stated in March, authorized representatives were provided a strip of paper, indicating the rate change, which was to start in April; however, they aren’t sure if all authorized representatives received the paper. Staff stated, in addition to the strip of paper, they verbally informed authorized representatives of the rate change.
Pertinent interviews conducted verified a strip of paper was provided at the beginning of March. LPA reviewed six children files and observed admission agreements indicating a rate change.

Based on interviews conducted and files reviewed, there is conflicting information from what was alleged; therefore, the above allegation is unsubstantiated. 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.

An exit interview was conducted, a copy of this report was provided to assistant director, and appeal rights were discussed/provided.

Notice of Site Visit issued and must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2