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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093622098
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:10:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 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
04/19/2023 and conducted by Evaluator Soleil Marx
COMPLAINT CONTROL NUMBER: 03-CC-20230419111249
FACILITY NAME:BAUTISTA, PERLAFACILITY NUMBER:
093622098
ADMINISTRATOR:BAUTISTA, PERLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 721-7896
CITY:SOUTH LAKE TAHOESTATE: CAZIP CODE:
96151
CAPACITY:14CENSUS: 7DATE:
05/22/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Perla BautistaTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Child sustained unexplained scratches while in care
Licensee is operating outside license terms and conditions
INVESTIGATION FINDINGS:
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On May 22nd, 2023, Licensing Program Analyst (LPA) Soleil Marx, met with Licensee, Perla Bautista, to close a complaint investigation alleging that a child sustained unexplained scratches while in care and that the licensee is operating outside license terms and conditions. LPA observed a census of seven children in care with the Licensee.

During the investigation, LPA inspected the facility, reviewed relevant documentation, observed interactions between staff and children in care, and conducted staff and parent interviews.

Based on LPAs observations, parent interviews, and record review of attendance logs, facility roster, and children’s files, LPA could not prove that the licensee is operating outside of the license terms and condition of the licensed capacity of 14 children in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
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 2
Control Number 03-CC-20230419111249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BAUTISTA, PERLA
FACILITY NUMBER: 093622098
VISIT DATE: 05/22/2023
NARRATIVE
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Interviews with parents did not reveal concerns of children being injured outside of normal childhood incidents and that they are notified promptly by licensee if it occurs. Observation and interview with staff revealed parents are notified at pick up for small injuries and called for more serious injuries and supervision is always maintained to minimize injuries. LPA did not gather any pertinent information that could prove that a child sustained unexplainable scratches while in care.

In conclusion, LPA did not collect validated pertinent evidence to prove that a child sustained unexplained scratches while in care or that the licensee is operating outside license terms and conditions

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, report reviewed with Director, appeal rights provided. Notice of Site was issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 584-3508
LICENSING EVALUATOR NAME: Soleil MarxTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2