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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618688
Report Date: 06/09/2020
Date Signed: 07/01/2020 09:08:06 AM



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
01/15/2020 and conducted by Evaluator Jeevun Birk
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200115140431
FACILITY NAME:HUBBARD, LATICEFACILITY NUMBER:
343618688
ADMINISTRATOR:HUBBARD, LATICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 684-0334
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 0DATE:
06/09/2020
ANNOUNCEDTIME BEGAN:
03:23 PM
MET WITH:Latice HubbardTIME COMPLETED:
04:14 PM
ALLEGATION(S):
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Provider restrained day care children in a carseat
INVESTIGATION FINDINGS:
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***THIS IS AN AMENDED REPORT***
Due to the COVID-19 pandemic Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a Tele-Inspection with Licensee, Latice Hubbard on 5/22/2020 at 3:30 PM in lieu of conducting a site inspection to deliver complaint findings for the above allegation. It was alleged that the Licensee had restrained Child 1 and Child 2 in their car seats on two seperate occasions. It was stated by the complainant that upon arrival to the facility C1 and C2 were observed to be in their car seats crying. LPA Birk-Miller collected documents and conducted an interview with the Licensee. During the interview with the Licensee, Latice Hubbard on 1/23/2020 it was stated that she knew the parent was coming to pick up the children, so she put their jackets on and had the children in their seats ready to go. Latice stated she liked having a routine and was just getting the children ready for pick up. The Licensee stated the children were in their seats for less than five minutes. LPA explained that children can not be left in car seats for any reason or any length of time. Based on conflicting statements the preponderance of evidence standard has not been met, therefore the allegation are found to be unsubstantiated.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020
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 53-CC-20200115140431
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: HUBBARD, LATICE
FACILITY NUMBER: 343618688
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/16/2020
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.



This requirement has not been met as evidenced by:
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The Licensee does not currently have infants in care and stated she understands that she may not place and/or leave children in car seats for any reason.

POC has been cleared through this inspection.
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Based on interviews the Licensee did not ensure that C1 and C2 were accorded safe, healthful, and comfortable accommodations by placing the children in their car seats for a duration of time. This poses and immediate health and safety risk to children 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: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
01/15/2020 and conducted by Evaluator Jeevun Birk
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20200115140431

FACILITY NAME:HUBBARD, LATICEFACILITY NUMBER:
343618688
ADMINISTRATOR:HUBBARD, LATICEFACILITY TYPE:
810
ADDRESS:8926 WILLOWSPRING COURTTELEPHONE:
(916) 684-0334
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 0DATE:
06/09/2020
ANNOUNCEDTIME BEGAN:
03:23 PM
MET WITH:Latice HubbardTIME COMPLETED:
04:14 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child sustained unexplained injury while in care
INVESTIGATION FINDINGS:
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2
3
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5
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7
8
9
10
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12
13
Due to the COVID-19 pandemic Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a Tele-Inspection with Licensee, Latice Hubbard on 5/22/2020 at 3:30 PM in lieu of conducting a site inspection to deliver complaint findings for the above allegation. It was alleged that Child 1 (C1) had gotten a scratch on their left arm and that there were inconsistencies in what had occurred. LPA conducted interviews with the Licensee, parents, and children. LPA collected documents and photos. The Licensee had stated she had not observed the scratch until an older child who was playing with C1 had brought it to her attention. The Licensee stated that she notified the parent right away. She stated that the scratch had peeled and had gotten bigger since she initially oberserved it. It was stated through interviews that C1 has a skin condition. Interviews with children did not cooberate how the alleged injury occurred or provide additional information. Parent interviews indictaed there were no concerns about the facility. Although the incident did occur there was a lack of evidence to determine how the alleged injury occurred. Based on a lack of evidence and inconsistent statements the above allegation was determined to be unsubstantiated. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020
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 4
Control Number 53-CC-20200115140431
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: HUBBARD, LATICE
FACILITY NUMBER: 343618688
VISIT DATE: 06/09/2020
NARRATIVE
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***THIS IS AN AMENDED REPORT***
Exit interview conducted. Notice of Site Visit was provided and posted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4