033622932-4-14-2021-53-CC-JSMH-C25NN6-20210416103612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 033622932
Report Date: 04/14/2021
Date Signed: 04/14/2021 07:14:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/03/2021 and conducted by Evaluator Aruna Sridharan

COMPLAINT CONTROL NUMBER: 53-CC-20210203153532

FACILITY NAME:	CABLE, CHONG		FACILITY NUMBER:	033622932
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 7	DATE:	04/14/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Chong Cable		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Lack of Supervision – Licensee left children unattended while they were playing out in front of facility.

INVESTIGATION FINDINGS:

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Due to State of Emergency Order due to COVID-19 Licensing Program Analyst (LPA) Aruna Sridharan met with the Licensee virtually via Facetime to deliver the finding for the above allegation. The report will be emailed to applicant for signatures and documented in 812. The Licensee stated she was caring for seven children which includes two infants, one preschooler and four school age children today, April 14, 2021.
The Reporting Party stated that they have observed 10 to 12 children of all ages outside without any adult supervision at least a block away from the Licensee’s facility. During the investigation, LPA Sridharan interviewed the Licensee, and several witnesses. The Licensee stated, there are times when she needs to go inside her facility to change a child’s diaper and leaves the children outside in her front yard, however, she said she can observe the children through her front window. Witness (W1) stated they have arrived at the facility and observed children outside in the front of the facility alone while the Licensee was inside. Based on the disclosure from the Licensee and W1’s observation there is a preponderance of evidence to substantiate the above allegation. Therefore, a Type A Deficiency was cited on the following LIC9099D document.

LPA Sridharan provided LIC 9224 to have parents acknowledge the receipt of a copy of this licensing report that documents a Type A deficiency cited at this facility on 4/14/21.
Upon receipt of Type A citations, licensee shall post and provide copies of this licensing report for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099 D in each child's file.
LPA discussed appeal rights and Appeal rights were provided.

Substantiated

Estimated Days of Completion: 70

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 53-CC-20210203153532

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CABLE, CHONG	FACILITY NUMBER: 033622932
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/15/2021 Section Cited CCR 102417(g)(6)	1 2 3 4 5 6 7	102417(g)(6)-Outdoor play shall be supervised by the licensee or caregiver. This was not met as evidenced by:-Based on the complaint investigation, licensee left children unattended in the front yard.	1 2 3 4 5 6 7	Licensee agrees to supervise, by being present or have an adult assistant supervise when children are playing in unfenced front yard.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

LIC9099 (FAS) - (06/04)

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