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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624247
Report Date: 07/09/2026
Date Signed: 07/13/2026 02:31:02 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
07/06/2026 and conducted by Evaluator Andrea Cortez
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20260706165415
FACILITY NAME:EXCELSIOR PRESCHOOL GOLD RIVER LLCFACILITY NUMBER:
343624247
ADMINISTRATOR:HEATHER ROBERTSONFACILITY TYPE:
850
ADDRESS:2317 GOLD MEADOW WAYTELEPHONE:
(916) 775-8618
CITY:GOLD RIVERSTATE: CAZIP CODE:
95670
CAPACITY:118CENSUS: 29DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Heather RoberstonTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Due to lack of supervision, child recevied unexplained injury.
INVESTIGATION FINDINGS:
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This is an amended report. Licensing Program Analysts (LPAs) Andrea Cortez and Sala Vang met with Director, Heather Roberston, for the purpose of delivering findings on a complaint investigation alleging a child received an unexplained injury due to lack of supervision.

During the investigation, the LPA interviewed staff, reviewed video footage, and made observations. It was alleged that a child (C1) was playing on the playground when they fell and injured themselves. Interviews confirmed that the injury did occur. The investigation determined a lack of supervision because the teacher could not explain how the child fell. The video showed two teachers present with one of the teacher’s back turned to the group and one standing behind train structure at the time of the incident.

Con't...see LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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-20260706165415
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: 07/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2026
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 as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.This requirement was not met as evidenced by...
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Director provided absence of supervision training to ensure that children are under direct visual supervision at all times. Staff are to follow established communication procedures, including the use of walkie talkies during emergencies or when assistance is needed.
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Based on interviews and a review of video footage,the licensee did not provide the level of care and supervision to meet the needs of a child resulting in unexplained injury.This poses an immediate health, safety, or personal rights risk to persons in care.
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Also, Director posted zoning maps on the playgrounds. POC has been met.
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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.
SUPERVISOR'S NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20260706165415
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
VISIT DATE: 07/09/2026
NARRATIVE
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In addition to this incident, during the course of the investigation an Unusual Incident Report (UIR) was self-reported by Director Heather Robertson. On 5/7/2026 at approximately 10:30 AM, a teacher in the four-year-old classroom became suddenly ill while supervising children. Due to the teacher’s disorientation, the teacher instructed a child to leave the classroom to locate the Director instead of using the classroom walkie-talkie as required by facility procedures.

The child exited the classroom by themself and proceeded to the playground in search of the Director. While on the playground, the child found another teacher and told them what happened. The child appeared stressed and worried. The child was then escorted back to the classroom by staff. LPA interviewed teacher, reviewed video footage, and took Director's statement.

Based on this information gathered during the investigation, the preponderance of evidence is met and the allegation is substantiated. LPA informed Director that this report, dated July 9, 2026, documents one Type A citation with a civil pently of $500.00 which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

LPA informed Director to provide a copy of this licensing report dated July 9, 2027 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 Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
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