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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 553622901
Report Date: 10/17/2024
Date Signed: 10/17/2024 02:24:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
10/15/2024 and conducted by Evaluator Tobias Lake
COMPLAINT CONTROL NUMBER: 53-CC-20241015150150
FACILITY NAME:SAFARI LEARNING ACADEMY (PRESCHOOL)FACILITY NUMBER:
553622901
ADMINISTRATOR:KATIE PACKFACILITY TYPE:
850
ADDRESS:18470 STRIKER COURTTELEPHONE:
(209) 588-0920
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:112CENSUS: 51DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ali CardozaTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Personal Rights: Inappropriate discipline
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tobias Lake met with Assistant Director, Ali Cordoza, for the purpose of opening a complaint investigation.

LPA toured the facility, observed the care and supervision of children, conducted interviews, and obtained the facility roster and other relevant evidence during today's visit. After reviewing the provided video evidence and interviews with staff, it was determined that a staff member used inappropriate discipline on
September 24, 2024. According to a video, Staff #1 forcefully moved a child to a time-out area. Therefore, the allegation of staff using inappropriate discipline is SUBSTANTIATED. A Type A citation is issued on the subsequent page of this report, 9099-D.

CONTINUED ON LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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 53-CC-20241015150150
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SAFARI LEARNING ACADEMY (PRESCHOOL)
FACILITY NUMBER: 553622901
VISIT DATE: 10/17/2024
NARRATIVE
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Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed Acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted in which the report was reviewed and discussed with Facility Representative. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 53-CC-20241015150150
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SAFARI LEARNING ACADEMY (PRESCHOOL)
FACILITY NUMBER: 553622901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/18/2024
Section Cited
CCR
101223(a)(3)
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Personal Rights 101223(a)(3) To be free from corporal or unusual punishment, infliction of pain, ... other actions of a punitive nature..., this requirement was not met as evidenced by:
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Director stated they had the staff review facility guidelines on positive redirection and provided caretaking resources. Director also provided all staff with additional information on positive redirection.
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Based on interviews with staff as well as record review, it was determined that staff at the facility used innapropriate discipline to redirect a child which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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 Director will submit a signature log of staff stating they understand the material by POC due 10/18/2024
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3