340312651-4-22-2022-03-CC-SDLA-CDWSHW-20220428135413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 340312651
Report Date: 04/22/2022
Date Signed: 04/22/2022 11:19:19 AM

Substantiated

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
04/15/2022 and conducted by Evaluator Alize Tillery

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220415114423

FACILITY NAME:	RAINBOW DAY CARE - INFANTS		FACILITY NUMBER:	340312651
ADMINISTRATOR:	WONG, MARIBELLE		FACILITY TYPE:	830
ADDRESS:	901 P STREET, SUITE 155B		TELEPHONE:	(916) 448-5231
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95814
CAPACITY:	12	CENSUS: 3	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Maribelle Wong		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Other - Facility staff failed to provide a safe sleep environment

INVESTIGATION FINDINGS:

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On Friday, April 22, 2022, at approximately 8:15 AM, Licensing Program Analysts (LPAs) Alize Tillery and Amanda Sutter, met with Director Maribelle Wong to open the complaint investigation for the above allegation. Upon arrival, today’s census was 3 infant children, supervised by 3 staff.

During the course of this investigation, LPA Tillery and LPA Sutter conducted interviews with the reporting party, director and 3 staff. During the investigation, LPAs observed a blanket hanging from a crib and observed play equipment stacked in another. Information obtained during interviews revealed that staff have used blankets for the children, while they are in the cribs, on at least one occasion.

This poses an immediate risk to children. LPAs discussed the importance of safe sleep regulations.
Based on information obtained during interviews and observation, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. A Type A deficiency is cited. See 809D for deficiency.

Report continues on 9099C.

Substantiated

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: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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-20220415114423

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: RAINBOW DAY CARE - INFANTS	FACILITY NUMBER: 340312651
	VISIT DATE: 04/22/2022

NARRATIVE

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Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/guardians of children newly enroll at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

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.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 03-CC-20220415114423

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: RAINBOW DAY CARE - INFANTS	FACILITY NUMBER: 340312651
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/25/2022 Section Cited CCR 101439.1(f)	1 2 3 4 5 6 7	(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met, evidenced by: Interview with staff member revealed that, on at least one occassion, a blanket was placed in the crib with a sleeping infant. This poses an immediate risk to childrn in care.	1 2 3 4 5 6 7	Staff will sign off on a form, created by the Director, that shows proof of conducting a training in regards to infant safe sleep regulations. Director will submit proof of removing items from the crib. Director will submit this form to LPA Tillery.
	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
	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: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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