343617373-11-16-2023-03-CC-KPES-CY2MVQ-20231129085706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343617373
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:20:17 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
10/24/2023 and conducted by Evaluator Michelle Perez

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20231024162443

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:	Krissann Vistica		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Supervision- Due to lack of supervision daycare child sustained an injury while in care

INVESTIGATION FINDINGS:

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On November 16, 2023, Licensing Program Analyst (LPA), Michelle Perez, arrived at approximately 12:15 PM 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 lack of supervision.
LPA found that a child (C1), had arrived in the morning and walking down two steps that led to the outside. As C1 was walking, a teacher (T1) was following immediately behind the child. As C1 stepped down the second step, C1 lost their footing and fell, resulting in a facial injury. T1 picked C1 up, took the child inside, cleaned and treated the wound and contacted the guardian within five (5) minutes. C1 one was not taken to the doctor's office. T1 reported the incident to the director, where it was documented and provided to the guardian. T1 provided updates of C1 for the next few hours to the guardian via an online app.

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-20231024162443

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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Based on the information obtained, LPA could not corroborate the allegation of lack of 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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