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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 053619656
Report Date: 10/08/2021
Date Signed: 10/08/2021 11:03:42 AM



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
07/22/2021 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210722151302
FACILITY NAME:ROE, LINDA A.FACILITY NUMBER:
053619656
ADMINISTRATOR:MILLER, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 754-9011
CITY:SAN ANDREASSTATE: CAZIP CODE:
95249
CAPACITY:14CENSUS: 14DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Linda RoeTIME COMPLETED:
11:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider does not treat child with dignity.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 8, 2021, Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of delivering complaint findings. LPA met with Licensee. LPA observed fourteen children supervised by two staff.
LPA Williams conducted an investigation regarding the complaint allegation listed above. Records were reviewed, interviews were conducted, and pertinent information was received to assist with the investigation. It was alleged that the Licensee does not treat a child in care (C4) with dignity. Information obtained from the investigation revealed that C4’s dietary restrictions were listed on the required licensing forms. Conflicting statements were received concerning the C4’s dietary needs outside of what was documented. Licensee reported that prior to the end of C4’s enrollment in her facility, the parent nor the child communicated C4’s dietary restrictions. Licensee acknowledged communicating with outside resources for C4 in an attempt to provide services in her home; however, was unable to obtain a scheduled visit due to C4’s enrollment ending. Based on the evidence gathered throughout the course of this investigation there was not a preponderance of evidence to prove or dismiss the allegation and therefore, the allegation is deemed unsubstantiated.
Exit interview conducted and notice of site provided to Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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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