340311130-7-28-2021-03-CC-SDLA-C5RMFQ-20210810093440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340311130
Report Date: 07/28/2021
Date Signed: 07/28/2021 05:39:19 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
06/03/2021 and conducted by Evaluator Alize Tillery

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210603160615

FACILITY NAME:	YMCA OF SUPERIOR CALIFORNIA- CDC INFANT		FACILITY NUMBER:	340311130
ADMINISTRATOR:	FUGATE, NANCY		FACILITY TYPE:	830
ADDRESS:	2021 W STREET		TELEPHONE:	(916) 452-9622
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	12	CENSUS: 8	DATE:	07/28/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Kristina Gage		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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License - Facility is operating over ratio

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Alize Tillery and Gagan Singh, met with Director Kristina Gage to conclude the investigation and deliver the findings to the above allegations. Upon arrival, today’s census was 8 children and 3 staff.

It was alleged that facility was operating over children to staff ratio. During the course of the investigation, LPA Tillery conducted interviews with the complainant, director, staff and random parents. LPA obtained and reviewed children’s sign in/out sheets, staff sign in/out records and children’s roster. Information obtained during interviews revealed that the facility is fully staffed.

Based on the investigation conducted, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. As a result, the allegation is UNSUBSTANTIATED.

LPAs reviewed the report with Director and provided copies. Appeal Rights were issued and discussed. A Notice of Site Visit was issued and Director acknowledges it must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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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