343617996-6-8-2021-03-CC-KPES-C3ZVG4-20210615162452

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343617996
Report Date: 06/08/2021
Date Signed: 06/08/2021 03:11:11 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
04/14/2021 and conducted by Evaluator Mai Lor

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210414143946

FACILITY NAME:	SAULTER, THERESA		FACILITY NUMBER:	343617996
ADMINISTRATOR:	SAULTER, THERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 729-7102
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	14	CENSUS: 10	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Theresa Saulter		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Licensee does not provide adequate supervision
Inappropriate/ rough interactions with children
Over Capacity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mai Lor conducted a complaint investigation at the above facility and met with licensee Theresa Saulter. Present during this inspection was licensee's husband acting as her assistant. Census included 10 day care children, two children under the age of two. The complaint alleged licensee does not provide adequate supervision when children are in the backyard, inappropriate/rough interactions with children such as yelling and pulling on children’s shirt to get their attention and operating at overcapacity.

During the investigation, LPA Lor conducted observation, obtained pertinent documents including children roster, text messages, and conducted interviews with children, parents and witnesses. Evidence obtained suggested the licensee’s assistant was present when two children were rough housing in the backyard which resulted in one child sustaining an injury; however, LPA Lor was unable to determine whether supervision at this given time was inadequate resulting in the injury.
(Report continues on subsequent LIC9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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 6

Control Number 03-CC-20210414143946

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: SAULTER, THERESA	FACILITY NUMBER: 343617996
	VISIT DATE: 06/08/2021

NARRATIVE

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Statements in interviews were inconsistent to determine the licensee yelled or had rough interaction with children in care and operating at over capacity. Based on the above, the allegations are determined to be unsubstantiated.

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

No Title 22 deficiencies cited. Exit interview conducted. Notice of site visit posted.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 6

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
04/14/2021 and conducted by Evaluator Mai Lor

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210414143946

FACILITY NAME:	SAULTER, THERESA		FACILITY NUMBER:	343617996
ADMINISTRATOR:	SAULTER, THERESA		FACILITY TYPE:	810
ADDRESS:	6944 BIG ARROW COURT		TELEPHONE:	(916) 729-7102
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	14	CENSUS: 10	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Theresa Saulter		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Unsafe use of a high chair and or sitting device
Infant feeding items riddled in mold and cloudy white film
Daycare children have access to off-limit areas

INVESTIGATION FINDINGS:

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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Mai Lor conducted a tele-inspection complaint investigation via Facetime with licensee Theresa Saulter. Census included 10 day care children, two children under the age of two. The complaint alleged high chair and or sitting device was unsafely used, infant feeding items riddled in mold and cloudy white film, and daycare children have access to off-limit areas.

During the investigation, LPA Lor conducted observation, obtained pertinent documents including children roster, text messages, and conducted interviews with children, parents, and witnesses. Evidence obtained revealed that infant feeding items were riddled in mold and cloudy white film because they were not properly cleaned and sanitized, the alleged infant was not safely secured in the high chair at the time of use which the licensee had to improvised the safety straps with a cloth, and daycare children were napping in off-limit areas. Based on the above, the above allegations are substantiated.
(Report continues on subsequent LIC9099)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 03-CC-20210414143946

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: SAULTER, THERESA	FACILITY NUMBER: 343617996
	VISIT DATE: 06/08/2021

NARRATIVE

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A finding that the complaint is substantiated means the allegation is valid because the preponderance of evidence standard has been met.

See subsequent LIC9099 for deficiencies cited. Exit interview conducted. Notice of site visit posted.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 03-CC-20210414143946

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: SAULTER, THERESA	FACILITY NUMBER: 343617996
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/09/2021 Section Cited CCR 102417(d)	1 2 3 4 5 6 7	The home shall provide safe toys, play equipment and materials.	1 2 3 4 5 6 7	Infant feeding items and high chair were removed from the home. New infant feeding items and booster chair have been purchased No further POC required.
	8 9 10 11 12 13 14	Based on observation, interviews and documents, the licensee failed to thoroughly clean infant feeding items resulting in mold and cloudy white film and infant not safely secured in high chair. This poses an immediate health, safety and personal rights risk to children in care.	8 9 10 11 12 13 14
CCR	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14

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 Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 03-CC-20210414143946

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: SAULTER, THERESA	FACILITY NUMBER: 343617996
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/22/2021 Section Cited CCR 102416.3(a)(6)	1 2 3 4 5 6 7	Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Case management was conducted by LPA on 4/16/21. Master bedroom and bedroom #2 has been changed from off-limit to on-limit. No further POC required.
	8 9 10 11 12 13 14	Based on photos and interviews, the licensee failed to notify licensing when changing an off-limit to an on-limit, which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

Page: 6 of 6