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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340311130
Report Date: 11/26/2024
Date Signed: 11/26/2024 02:12:34 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2024 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20241024125348
FACILITY NAME:YMCA OF SUPERIOR CALIFORNIA - CDC INFANTFACILITY NUMBER:
340311130
ADMINISTRATOR:MELIA SAVAGEFACILITY TYPE:
830
ADDRESS:1926 V STREETTELEPHONE:
(916) 457-9622
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:12CENSUS: 5DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jessica Thomas TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee did not ensure ratios were maintained.
Licensee allowed unqualified staff to provide care to infants without supervison.
INVESTIGATION FINDINGS:
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On 11/26/2024, License Program Analyst (LPA) Pa Dao Vang conducted a complaint investigation inspection made to the regional office on 8/2/2024. LPA met with the Director Jessica Thomas and Tiffany Davidson to investigate on the allegation of Licensee did not ensure ratios were maintained and allowed unqualified staff to provide care to infants without supervision.LPA observed 5 children supervised by 2 staff in the infant classroom during breakfast.

During the inspections on 10/29/2024 and 11/26/2024, LPA conducted interviews, made observations, and gathered documentation, and reviewed files. According to parent interviews, they have no concerns regarding the above allegations at the facility. Most of the staff stated there are a fully qualified Teacher supervising the infant room at all times. Based on LPA’s investigation, there are no California Code of Regulations, Title 22 violation at the facility.

Continue report on LIC 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao VangTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 2
Control Number 03-CC-20241024125348
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YMCA OF SUPERIOR CALIFORNIA - CDC INFANT
FACILITY NUMBER: 340311130
VISIT DATE: 11/26/2024
NARRATIVE
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Therefore, although the alleged violations may have happened or are valid, the preponderance of evidence standard has not been met to fully prove or disprove that they did or did not occur, therefore they are unsubstantiated. There is no deficiency issued today. An exit interview was conducted and notice of site visit and appeal rights were provided to Director Jessica Thomas.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao VangTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2