343617373-11-16-2023-03-CC-KPES-CY2MM8-20231129084328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343617373
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:19:44 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
10/26/2023 and conducted by Evaluator Michelle Perez

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20231026153250

FACILITY NAME:	TIAMORE CHILDREN'S CENTER		FACILITY NUMBER:	343617373
ADMINISTRATOR:	VISTICA, KRISANN		FACILITY TYPE:	850
ADDRESS:	8344 MADISON AVENUE		TELEPHONE:	(916) 717-2885
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	30	CENSUS: 18	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Krisann Vistica		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Supervision- Staff did not adequately supervise day care child resulting in daycare child sustaining an injury while in care.

INVESTIGATION FINDINGS:

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On November 16, 2023, Licensing Program Analyst (LPA), Michelle Perez, arrived at approximately 12:15PM to deliver findings for the above allegation. Upon arrival, there were 18 children, supervised by 4 staff.
LPA investigated the above allegation, through interviews with the Reporting Party (RP) and staff, making observations and touring the facility. It was alleged that a child sustained an injury due to inadequate supervision.

LPA found that a child (C1) was sitting in a small red chair, that was very low to the ground, when another child (C2) came to sit with C1, in the same chair. There was a teacher (T1) that was present, and standing directly in front of the children, and decided to take a photo of the children, to share with their guardians. Another teacher (T2), was standing directly behind T1, facing the opposite direction while supervising other children.

Cont on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Perez	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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-20231026153250

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: TIAMORE CHILDREN'S CENTER	FACILITY NUMBER: 343617373
	VISIT DATE: 11/16/2023

NARRATIVE

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T1, saw the chair fall on its side, with both children sitting in it, and C1 fell over with the chair and hit their head on a cement step nearby. T1, immediately picked up C1 and took the child inside to provide treatment to the wound. LPA found that within five (5) minutes, T1 contacted the guardians of C1 and reported the incident. T1 also reported the incident to the director, which was documented in an incident report to the guardians and to licensing. C1 was picked up from care and taken to the doctors for additional treatment.

Based on the information obtained, LPA could not corroborate the allegation of inadequate supervision. LPA found that 100% supervision was provided and treatment was administered.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all allegations are unsubstantiated.

A notice of site visit was provided and will be posted for 30 days.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Michelle Perez	TELEPHONE: (916) 594-3812
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

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