340310097-2-1-2023-03-CC-KPES-CPPLW2-20230307080624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340310097
Report Date: 02/01/2023
Date Signed: 02/01/2023 01:41:19 PM

Unsubstantiated

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
01/12/2023 and conducted by Evaluator Christopher Bello

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20230112112002

FACILITY NAME:	4TH R - SUTTERVILLE		FACILITY NUMBER:	340310097
ADMINISTRATOR:	KAWAHARA, STACY		FACILITY TYPE:	840
ADDRESS:	4967 MONTEREY WAY		TELEPHONE:	(916) 277-6103
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95822
CAPACITY:	150	CENSUS: 13	DATE:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Stacey Kawahara		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Daycare child sustained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christopher Bello arrived at approximately 12:45pm and met with Director Stacey Kawahara to close a complaint investigation, regarding the above allegation. It was alleged that a daycare child got injured from being picked up resulting in bruising. Upon arrival, LPA observed 13 Children with three teachers. During the investigation LPA made observations, gathered documents pertaining to the investigation and conducted interviews. Parent, staff and children’s interviews did not corroborate the allegation. Documents gathered did not corroborate the allegation. Based on LPAs' investigation, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. Stacey stated that she and her families have confidence in her staff and that they strive to provide a safe and fun environment for their children. Although the allegation 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.

There were no Title 22 deficiencies during today’s investigation. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023

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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