<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313617358
Report Date: 10/24/2019
Date Signed: 10/24/2019 01:07:50 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
10/21/2019 and conducted by Evaluator Amanda Blesi
COMPLAINT CONTROL NUMBER: 03-CC-20191021144249
FACILITY NAME:BARAJAS, CRYSTALEFACILITY NUMBER:
313617358
ADMINISTRATOR:BARAJAS, CRYSTALEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 821-7690
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 12DATE:
10/24/2019
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Crystale BarajasTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee allows daycare child in off-limits areas
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA's Amanda Blesi and Katrina Owens arrived to open the above complaint. Upon arrival LPA's observed 12 children in care four of whom are infants. Assistants Amber and Rebecca were also present. LPA's interviewed the licensee regarding the allegation and it was determined that Licensee provides a date night once a month to families in care. The date night is held on Friday from 5:30pm - 8:30pm. Licensee disclosed that the children are allowed upstairs during the date night which is an off limit area. LPA's inpsected the off limit upstairs and determined there were no Title 22 violations observed. The preponderance of evidence standard was met today through the interview with licensee. The allegation was found to be substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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-20191021144249
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: BARAJAS, CRYSTALE
FACILITY NUMBER: 313617358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited
CCR
102416.3(a)(6)
1
2
3
4
5
6
7
Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
1
2
3
4
5
6
7
Licensee understands that because she holds a license through the Department, she is subject to Title 22 Regulations when providing care and supervision to children from more than one family. Licensee understands she cannot use off limit areas for children in care.

***Deficiency cleared during visit***
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Licensee dislcosed that she allowed enrolled day care children to use an off limit area during date night which was held after day care hours in her home. Date night is a service that is provided to enrolled day care children and some friends of the family.
8
9
10
11
12
13
14
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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3