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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340320736
Report Date: 07/23/2021
Date Signed: 07/23/2021 02:37:53 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
07/14/2021 and conducted by Evaluator Christopher Bello
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210714140607
FACILITY NAME:POPPY PATCH-PHASE IIFACILITY NUMBER:
340320736
ADMINISTRATOR:DOROTHEA JACKSONFACILITY TYPE:
850
ADDRESS:9645 BUTTERFIELDTELEPHONE:
(916) 845-6033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: 13DATE:
07/23/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Shanel TateTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is out of ratio.
Director does not spend a sufficient amount of time at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor upon arrival met with staff Kelly Pettigrew to open and close a complaint regarding the above allegations. LPAs observed at approximately 10:51am one teacher with 13 preschool children. It was alleged that “Facility is out of ratio”. Based on observations and interviews the preponderance of evidence standard has been met therefore the allegation is founded to be SUBSTANTIATED. It was alleged that facility director does not spend sufficient time at the facility. Based on consistent statements in interviews the preponderance of evidence standard has been met therefore the allegation is SUBSTANTIATED. Title 22 deficiencies are cited on the subsequent page of this report. Type Acknowledgement forms are to be signed by current parent of the facility and new parents for the next twelve months. LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit posted which must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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
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
07/14/2021 and conducted by Evaluator Christopher Bello
COMPLAINT CONTROL NUMBER: 03-CC-20210714140607

FACILITY NAME:POPPY PATCH-PHASE IIFACILITY NUMBER:
340320736
ADMINISTRATOR:DOROTHEA JACKSONFACILITY TYPE:
850
ADDRESS:9645 BUTTERFIELDTELEPHONE:
(916) 845-6033
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY:60CENSUS: 13DATE:
07/23/2021
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Shanel TateTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Facility does not have an adequate food supply.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor upon arrival met with staff Kelly Pettigrew to open and close a complaint investigation regarding the above allegation. It was alleged that “Facility does not have an adequate food supply”. Staff and children interviews had inconsistent statements regarding the allegation. 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. An exit interview was conducted and a Notice of Site Visit posted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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 3
Control Number 03-CC-20210714140607
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: POPPY PATCH-PHASE II
FACILITY NUMBER: 340320736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2021
Section Cited
CCR
101216.3(a)
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There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement has not been met by evidence: LPAs observed one teacher with 13 children. This is considered as an immediate risk to the
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Director stated:

Deficiency will be cleared by LPA follow-up inspection.

POC due date 7/23/2021
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children in care.
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Type A
07/23/2021
Section Cited
CCR
101215.1(d)
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The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation. This requirement has not been met by evidence: Based on staff interviews. This is considered as an immediate risk to the children in care.
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Director stated:

Deficiency will be cleared by LPA follow-up inspection.

POC due date 7/23/2021
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3