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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343610146
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:44:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 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
12/01/2022 and conducted by Evaluator Mandie Goodwin
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20221201120924
FACILITY NAME:4TH R - WITTER RANCHFACILITY NUMBER:
343610146
ADMINISTRATOR:COOPER, SHANNONFACILITY TYPE:
840
ADDRESS:3790 POPPY HILL WAYTELEPHONE:
(916) 566-1559
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:130CENSUS: 0DATE:
02/22/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mahalia Mitchell-OlsonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff not properly supervising children in care
INVESTIGATION FINDINGS:
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On February 22nd, 2023 Licensing Program Analyst (LPA) Mandie Goodwin met with Facility Representative Mahalia Mitchell-Olson to close a complaint investingation and deliver findings. There were no children in care at time of arrival.

It was alleged that staff were not properly supervising children in care. It was found that on one instance while children were playing outside a basketball practice was also occuring on the same playground and a parent on the team was interacting with a child in a way that made the child feel uncomfortable. During the course of the investigation, LPA interviewed staff members, children in care, and parents. Through interviews it was found that staff was made aware of the interaction, however neither of the 2 staff members outside at the time (Staff #1 and Staff #2) had directly observed the interaction take place. Interviews also disclosed that a dog was loose near the playground at the time and the staff members were directing their attention towards keeping children safetly away from the dog.
Report continues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mandie GoodwinTELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
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 4
Control Number 03-CC-20221201120924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: 4TH R - WITTER RANCH
FACILITY NUMBER: 343610146
VISIT DATE: 02/22/2023
NARRATIVE
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When the child spoke to a staff member about the incident, the staff member did tell the child to stay away from the area, however the child was able to continue to return. LPA observed the playground and learned that both playgrounds were in use during the time of basketball practice, and that parents of the basketball team members were allowed to be present on the playground during practice.

Based on interviews and observations, the preponderance of evidence standard has been met; therefore the above allegation is substantiated. A title 22 deficiency is cited on LIC 9099-D. Appeal rights were provided and exit interview was conducted with Facility Representative Mahalia Mitchell-Olson. A notice of site visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mandie GoodwinTELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20221201120924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: 4TH R - WITTER RANCH
FACILITY NUMBER: 343610146
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited
CCR
101229(a)(1)
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... (1) No child shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement is not met as evidence by:

Based on interviews and observation, the facility did not comply with the section
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During basketball practice students will stay on the other blacktop area, closest to 4th R for optimal supervision. Supervisor will write the plan for playground use and supervision.
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above by being unable to directly observe an interaction between an adult and student in care, due to a dog being loose. The child then was able to continued to return to the area. This poses a potential health, safety or personal rights risk to persons in care.
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mandie GoodwinTELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4