053622109-8-7-2023-53-CC-KGUA-CW3PFW-20230927111723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 053622109
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:37:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
06/29/2023 and conducted by Evaluator Tobias Lake

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20230629102041

FACILITY NAME:	HENDERSON, JENNIFER		FACILITY NUMBER:	053622109
ADMINISTRATOR:	JENNIFER HENDERSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 649-6497
CITY:	VALLEY SPRINGS	STATE: CA	ZIP CODE:	95252
CAPACITY:	14	CENSUS: 12	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee, Jennifer Henderson		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Licensee transported day-care child in an unsafe manner.

INVESTIGATION FINDINGS:

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On 08/07/2023 at 02:30 PM, Licensing Program Analyst (LPA) Tobias Lake met with Licensee, Jennifer Henderson, to conduct interviews and to deliver the findings of the complaint investigation regarding the above allegation. During the course of the investigation, LPA Lake conducted interviews with children, observations, and obtained information pertaining to the allegation. It was alleged that the licensee transported day-care children in an unsafe manner. Interviews with children who are transported did not indicate a history of unsafe transportation, and LPA observed licensee drive for a child pick up and did not observe unsafe driving. Based on the information obtained throughout the course of this investigation, the above allegations could not be substantiated or dismissed. 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, therefore the finding is UNSUBSTANTIATED. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Tobias Lake	TELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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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