343616666-1-21-2022-03-CC-SDLA-CAZPDG-20220125101331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343616666
Report Date: 01/21/2022
Date Signed: 01/21/2022 11:58:22 AM

Unsubstantiated

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
08/09/2021 and conducted by Evaluator Michelle Pascual

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210809153318

FACILITY NAME:	SETA - ELKHORN HEADSTART		FACILITY NUMBER:	343616666
ADMINISTRATOR:	SIMPSON, AFIYA		FACILITY TYPE:	850
ADDRESS:	5249 ELKHORN BLVD.		TELEPHONE:	(916) 263-5353
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95842
CAPACITY:	88	CENSUS: 24	DATE:	01/21/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Barbara Atkinson		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Personal Rights- A child sustained a burn while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Michelle Pascual met with Facility Representative Barbara Atkinson at approximately 11:30 AM to deliver the findings for the above allegation. The complaint alleged a child sustained a burn while in care when child used the outdoor slide. The investigation was conducted by the Investigative Branch (IB). During the investigation, IB Investigator Andrew Murrow conducted interviews with children, staff, and the reporting party. Furthermore, Investigator Murrow obtained relevant medical documentation, made observations, and reviewed all relevant documentation from the facility. Investigator Murrow found through interviews with the children in care, no one witnessed any injuries of a child sustaining a burn. Investigator Murrow also found through the interviews with the Site Supervisor and a teacher that adequate supervision was provided during outdoor play time and no one witnessed any injuries regarding a burn while the children were outside playing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

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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Control Number 03-CC-20210809153318

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: SETA - ELKHORN HEADSTART	FACILITY NUMBER: 343616666
	VISIT DATE: 01/21/2022

NARRATIVE

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Moreover, if a child had been burned during play time, staff stated they would have tended to the child and made appropriate phone calls. No other children reported injuries of a burn during outside play time. Investigator Murrow spoke to parents of children who are in care and found the parents were comfortable with the school and the care provided by the teachers. Furthermore, their children have not reported any injuries of burns while in care.

Based on the information gathered throughout the course of this investigation there was not sufficient evidence nor information to support or dismiss the above allegation. Therefore, the finding for the above allegation was determined to be UNSUBSTANTIATED. An exit interview was conducted in which the report was reviewed and discussed with the licensee

Appeal rights were discussed and with licensee.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021

LIC9099 (FAS) - (06/04)

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