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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313615176
Report Date: 02/16/2021
Date Signed: 02/16/2021 05:36:59 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
02/08/2021 and conducted by Evaluator Mai Lor
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210208102332
FACILITY NAME:CUNNINGHAM, ROBINFACILITY NUMBER:
313615176
ADMINISTRATOR:CUNNINGHAM, ROBINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 906-2890
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:14CENSUS: 5DATE:
02/16/2021
UNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Robin CunninghamTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Licensee inappropriately handled daycare child resulting in bruising
Licensee yelled at daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mai Lor and Regional Manager (RM) Jennifer Brekke met with licensee Robin Cunningham on 2/16/21 at the above facility for the purpose of conducting and delivering complaint investigation findings on the above allegations. It was alleged that the licensee inappropriately handled a day care child by dragging the daycare child by the ankles which resulted in bruising, and the licensee yelled at the daycare child during this interaction. The investigation was conducted by Auburn Police Department and Investigator Joe Balarie. A self-reported unusual incident report (UIR) was received on 2/9/21. The UIR described the licensee took the daycare child by the feet/ankle and slid him 10 to 12 feet to the nap room. Licensee denied yelling at the child during this interaction.

Based on the above, the allegations are substantiated meaning the preponderance of evidence has been met.

(Report continues on subsequent LIC9099)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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-20210208102332
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: CUNNINGHAM, ROBIN
FACILITY NUMBER: 313615176
VISIT DATE: 02/16/2021
NARRATIVE
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Title 22 deficiency cited on the subsequent page of this report. The licensee was informed to provide a copy of the Evaluation Report and the Type “A” Deficiency cited to the parents and guardians of children currently enrolled in care, and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 shall be maintained in all children's files.

An exit interview was conducted. Appeal rights was provide to the licensee.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20210208102332
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: CUNNINGHAM, ROBIN
FACILITY NUMBER: 313615176
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/17/2021
Section Cited
CCR
102423(a)(4)
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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
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Temporary Suspension Order served on February 16, 2021.
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This requirement is not met as evidenced by: Based on record review, the licensee dragged a daycare child by the ankles and yelled at the daycare child during this interaction. This poses an immediate health, safety or personal rights risk to persons in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3