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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393614120
Report Date: 01/10/2024
Date Signed: 01/10/2024 02:29:46 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
12/13/2023 and conducted by Evaluator Tiffanie Diep
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231213083034
FACILITY NAME:REFUGE CHRISTIAN PRESCHOOL & KINDERGARTENFACILITY NUMBER:
393614120
ADMINISTRATOR:LORI SHERMANFACILITY TYPE:
850
ADDRESS:486 BUTTON AVENUETELEPHONE:
(209) 825-1095
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:120CENSUS: 30DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Domarina BeitsayadTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Neglect/Lack of Supervision - Child sustained an unexplained bruise while in care
INVESTIGATION FINDINGS:
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On 01/10/2024 at 12:15 PM, Licensing Program Analyst (LPA) Tiffanie Diep met with Director Domarina Beitsayad for the purpose of an unannounced complaint visit to deliver the finding regarding the above allegation. LPA observed four staff supervising 30 children.

It was alleged that a child (C1) sustained an unexplained bruise while in care. Throughout the course of the investigation, LPA made observations at the facility, obtained relevant documents, and conducted interviews with the reporting party (RP), staff, day care children, and multiple parents.

Continues on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 7
Control Number 53-CC-20231213083034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: REFUGE CHRISTIAN PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 393614120
VISIT DATE: 01/10/2024
NARRATIVE
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Continued from 9099 (Page 2)

An interview with RP disclosed C1 was hit with an object and injured on or about 12/06/2023 while at the facility. During interviews with staff, it was denied that the incident occurred as staff did not disclose witnessing C1 show signs of distress while in care. Interviews conducted and records reviewed did not reveal any reports made by staff indicating C1 sustained an injury on or about 12/06/2023 while at the facility. Information obtained revealed the object was an insulated water bottle. Messages exchanged between staff and C1’s authorized representative on 12/06/2023 revealed staff were notified about the incident after C1 left the facility that evening. A photo of C1 taken on the late morning of 12/07/2023 revealed a bruise on their cheek. Although it could not be determined how C1 sustained the bruise, it is determined that an injury resulting in a bruise occurred while C1 was in care at the facility based on the photo.

Based on observations made at the facility, information obtained during interviews, and records reviewed, 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 9099-D.

LPA Tiffanie Diep informed the director, Domarina Beitsayad, that this report dated 01/10/2024 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Tiffanie Diep informed Director to provide a copy of this licensing report dated 01/10/2024 that documents any Type A citation 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 Acknowledgment of Receipt of Licensing Reports (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was conducted and report was reviewed with the director, Domarina Beitsayad. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 53-CC-20231213083034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: REFUGE CHRISTIAN PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 393614120
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
01/11/2024
Section Cited
CCR
101229(a)(1)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1)...Supervision shall include visual observation.

This requirement is not met as evidenced by:
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LPA discussed care and supervision of children with Director. Director provided a written plan of action during the visit regarding supervision training for staff, which includes watching the video "Supervising Children in Child Care Centers" provided on the Department's website.
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Based on observations, interviews conducted, and records reviewed, it was revealed that C1 sustained an injury resulting in a bruise on their cheek while in care at the facility that could not be explained by staff which poses an immediate health, safety, or personal rights risk to children in care.
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Director agreed to provide LPA with signatures from staff for verification by close of business on 01/12/2024.
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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: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
12/13/2023 and conducted by Evaluator Tiffanie Diep
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231213083034

FACILITY NAME:REFUGE CHRISTIAN PRESCHOOL & KINDERGARTENFACILITY NUMBER:
393614120
ADMINISTRATOR:LORI SHERMANFACILITY TYPE:
850
ADDRESS:486 BUTTON AVENUETELEPHONE:
(209) 825-1095
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:120CENSUS: 30DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Domarina BeitsayadTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Personal Rights - Staff did not prevent day care child from bullying another day care child
INVESTIGATION FINDINGS:
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On 01/10/2024 at 12:15 PM, Licensing Program Analyst (LPA) Tiffanie Diep met with Director Domarina Beitsayad for the purpose of an unannounced complaint visit to deliver the finding regarding the above allegation. LPA observed four staff supervising 30 children.

It was alleged that staff did not prevent a day care child from bullying another day care child. Throughout the course of the investigation, LPA made observations at the facility, obtained relevant documents, and conducted interviews with the reporting party, staff, day care children, and multiple parents.

Continues on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 53-CC-20231213083034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: REFUGE CHRISTIAN PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 393614120
VISIT DATE: 01/10/2024
NARRATIVE
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Continued from 9099 (Page 2)

During a previous visit, LPA did not observe behavior from children in care at the facility consistent with acts of bullying. Interviews conducted did not disclose children in care being bullied at the facility. Records reviewed revealed a few concerning incidents of children in care. It was revealed most incidents were age-appropriate involving biting, hitting, pushing, and scratching. Information obtained did not indicate targeted behavior taking place at the facility amongst children in care consistent with acts of bullying. It is determined there was not sufficient information evident to support the allegation that staff did not prevent a day care child from bullying another day care child.

Based on observations made at the facility, information obtained during interviews, and records reviewed, it is determined that the allegation could not be substantiated or dismissed. Although the allegation might 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.

An exit interview was conducted and report was reviewed with the director, Domarina Beitsayad. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7