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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 574501013
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:38:05 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
06/14/2024 and conducted by Evaluator Jennie Tedlos
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240614112607
FACILITY NAME:L'ACADEMY LANGUAGE IMMERSION PRESCHOOL DAVISFACILITY NUMBER:
574501013
ADMINISTRATOR:POON, EVAFACILITY TYPE:
860
ADDRESS:2550 CANNERY LOOPTELEPHONE:
(408) 916-7536
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:68CENSUS: DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Diana GonzalezTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not meet safe sleep requirements.
INVESTIGATION FINDINGS:
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On August 21, 2024, Licensing Program Analyst (LPA) Jennie Tedlos met with Assistant Director, Diana Gonzalez to deliver the findings of the complaint investigation regarding the above allegation. LPA observed 5 children.
LPA Tedlos conducted an investigation regarding the complaint allegation listed above. During the course of the investigation LPA toured the facility, conducted interviews with the Reporting Party (RP), Staff Members and parents of children that attend or who have attended the facility. LPA also obtained pertinent information to assist with the investigation.
It was alleged that the “Staff did not meet safe sleep requirements”. Interviews and file reviews were consistent in confirming that a child was swaddled in care by a staff member via a sleep sack provided by the child’s authorized representatives. Following the incident, a staff meeting was held regarding safe sleep practices and the regulation prohibiting swaddling. LPA informed the facility that sleep sacks of any kind are against Title-22 regulations and are not allowed to be used at the facility.
Report continues on 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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 5
Control Number 53-CC-20240614112607
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: L'ACADEMY LANGUAGE IMMERSION PRESCHOOL DAVIS
FACILITY NUMBER: 574501013
VISIT DATE: 08/21/2024
NARRATIVE
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Based on interviews, file review, and observations conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A Type-A Deficiency is cited on a subsequent 9099-D page.
An exit interview was conducted, and the report was reviewed with the Assistant Director, Diana Gonzalez. LPA provided the Assistant Director with Appeal Rights. A Notice of Site visit was posted by LPA 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: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
06/14/2024 and conducted by Evaluator Jennie Tedlos
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240614112607

FACILITY NAME:L'ACADEMY LANGUAGE IMMERSION PRESCHOOL DAVISFACILITY NUMBER:
574501013
ADMINISTRATOR:POON, EVAFACILITY TYPE:
860
ADDRESS:2550 CANNERY LOOPTELEPHONE:
(408) 916-7536
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:68CENSUS: 5DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Diana GonzalezTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not provide a safe environment.
Staff did not properly store child's medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennie Tedlos met with Assistant Director, Diana Gonzalez to deliver findings of the complaint investigation regarding the above (2) allegations submitted to Licensing. There were 5 children during the visit.

It was alleged that “Staff did not provide a safe environment”. There was a concern that a child was exposed to an allergen by another child who attends the facility. During the investigation, LPA Tedlos obtained documents, conducted observations and interviews with administration, staff, and parents of children who attend the facility. Interviews with administration and staff at the center revealed conflicting statements about the incident which did not support the allegation.
It was alleged that “Staff did not properly store child's medication”. There was a concern that a child’s medication was improperly stored at the facility. Interviews and LPA's observations did not support this allegation.
Report continues onto 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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 5
Control Number 53-CC-20240614112607
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: L'ACADEMY LANGUAGE IMMERSION PRESCHOOL DAVIS
FACILITY NUMBER: 574501013
VISIT DATE: 08/21/2024
NARRATIVE
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Based on the information obtained throughout the course of this investigation for the above allegations, LPA Tedlos determined that the allegations were found to be UNSUBSTANTIATED, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit Interview was conducted with the Assistant Director, Diana Gonzalez.

A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20240614112607
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: L'ACADEMY LANGUAGE IMMERSION PRESCHOOL DAVIS
FACILITY NUMBER: 574501013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
101430(a)(3)(C)
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(a) Notwithstanding Section 101230, the following shall apply:...(3) All infants shall be given the opportunity to sleep without distraction or disturbance from other activities at the center whenever the infant desires...(C) An infant shall not be
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The facility staff has done a training regarding sleep safe and sleep safe. The facility staff will watch the Licensing Safe Sleep video. Staff will sign a statement stating they watched and understand the video. The facility will send the signatures to LPA Tedlos by the POC due date.
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swaddled while in care...

This was not met as evidenced by:

LPA learned that a child was swaddled in care.This poses an immediate health & safety risk to children 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: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5