313617391-5-4-2020-03-CC-KPES-BPEUBF-20200508152615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 313617391
Report Date: 05/01/2020
Date Signed: 05/04/2020 09:40:11 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
03/09/2020 and conducted by Evaluator Jeremey McClain

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20200309093953

FACILITY NAME:	MEDVECKI, VALQUIRIA		FACILITY NUMBER:	313617391
ADMINISTRATOR:	MEDVECKI, VALQUIRIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 412-6632
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	14	CENSUS: 10	DATE:	05/01/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Valquiria Medvecki		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility is out of ratio
Child was denied access to the bathroom

INVESTIGATION FINDINGS:

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On May 1,2020, Licensing Program Analyst (LPA) Jeremey McClain conducted a Tele Inspection for the purpose of concluding a complaint investigation. A census of 10 children was verified during the inspection. Licensee's assistant was present during the inspection. LPA investigated the following allegations: 1) the licensee leaves the home during operating hours leaving the assistant out of ratio for a period of time and 2) children were denied access to main are of the home to use the bathroom. During the investigation, LPA conducted interviews with the licensee, and parents, as well as current and former assistants. Based on the evidence gathered, LPA determined these allegations to be unsubstantiated. There was inconclusive evidence to corroborate the allegation or dismiss it completely.

No Title 22 deficiencies were found related to these allegations. LPA sent this report to the Licensee for review and signature, as well as appeal rights via email. A Notice of Site Visit that must be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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 4

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
03/09/2020 and conducted by Evaluator Jeremey McClain

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20200309093953

FACILITY NAME:	MEDVECKI, VALQUIRIA		FACILITY NUMBER:	313617391
ADMINISTRATOR:	MEDVECKI, VALQUIRIA		FACILITY TYPE:	810
ADDRESS:	508 BORGA COURT		TELEPHONE:	(916) 412-6632
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	14	CENSUS: 10	DATE:	05/01/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Valquiria Medvecki		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Lack of Supervision resulted in a child being injured while in care

INVESTIGATION FINDINGS:

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On May 1,2020, Licensing Program Analyst (LPA) Jeremey McClain conducted a Tele Inspection for the purpose of concluding a complaint investigation. A census of 10 children was verified during the inspection. Licensee's assistant was present during the inspection. LPA investigated an allegation that there was a lack of supervision that resulted in a child being injured. During the investigation, LPA conducted interviews with the licensee, and parents, as well as current and former assistants. LPA also observed injuries sustained by a child in care.
On February 28, 2020 while playing outside, a child pulled string from loose carpet and wrapped it around another the neck of another child in care, resulting in an injury to the child’s neck. Based on the evidence gathered, LPA determined the allegation to be substantiated. LPA determined there was enough evidence to support the allegation. Evidence shows that the child had enough time to pull string from loose carpet and proceed to cause injury to another child in care without being noticed before the injured child screamed.
Report continued on the following page.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 03-CC-20200309093953

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: MEDVECKI, VALQUIRIA	FACILITY NUMBER: 313617391
	VISIT DATE: 05/01/2020

NARRATIVE

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Title 22 deficiencies are cited on the subsequent page of this report. If not corrected, these violations pose an immediate risk to the health and safety of children in care. Licensee acknowledges, that upon receipt of a TYPE A Deficiency, a LIC 9099-D with Type A deficiencies shall be posted for 30 days. Licensee also acknowledges that they must provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. LPA provided an LIC 9224, which must be signed by parents/guardians and kept with the children's files.

LPA sent this report to the Licensee for review and signature, as well as appeal rights via email. A Notice of Site Visit that must be posted for 30 days.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 03-CC-20200309093953

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: MEDVECKI, VALQUIRIA	FACILITY NUMBER: 313617391
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/01/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/04/2020 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights.(a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee... These rights include, but are not limited to, the following:(2)To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.	1 2 3 4 5 6 7	Licensee has removed the carpet from the back yard. Licensee will implement a plan with her assistant increase the supervision of children in care to lessen the risk of injury to children in care. Plan will be submitted to LPA by the POC Due Date: 05/04/2020.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interviews conducted during LPA’s investigation. Interviews were conclusive that on February 28th, 2020, a child was able to injure another child’s neck using strings pulled from loose carpet that was placed outside in the play area by licensee. The child went unsupervised long enough to injure another child. If not corrected, this poses an immediate risk to the health and safety of children in care.	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 Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClain	TELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC9099 (FAS) - (06/04)

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