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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618991
Report Date: 10/04/2019
Date Signed: 10/04/2019 11:09:11 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
07/19/2019 and conducted by Evaluator Joleen Kenney
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20190719115115
FACILITY NAME:SWANSON, KATHERINEFACILITY NUMBER:
343618991
ADMINISTRATOR:SWANSON, KATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 419-9784
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: DATE:
10/04/2019
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Katherine Swanson, LicenseeTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Adults in the home are not associated to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Joleen Kenney and Chayntel Hunter conducted an unannounced complaint inspection and met with the Licensee, Katherine Swanson. It was alleged that adults in the home are not associated to the facility. It was stated that the Licensee's adult daughter (A1) and the daughter's spouse (A2) were living in the home without a criminal record clearance or association to the facility. The Licensee stated that A1 has lived in her home for periods of time but did not provide specific dates or time frames. The Licensee also stated that A1 and A2 lived with her for a period of time prior to getting married but since they got married A2 has lived in another home and not lived in her home since. LPA Kenney was unable to find any documentation to indicate that either one of the individuals have ever had a criminal record clearance or association to the licensed facility.

Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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 3
Control Number 03-CC-20190719115115
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: SWANSON, KATHERINE
FACILITY NUMBER: 343618991
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2019
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department.
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The Licensee stated that A1 and A2 do not reside in the home currently and stated that she understands that all adults that reside or work in the licensed day-care home must have a criminal record clearance and association.

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This requirement is not met as evidenced by: It was stated that A1 lived in the home for a period of time without a criminal record clearance. It was also stated that A2 lived in the home previously without a criminal record clearance or association to the licensed facility. This is an 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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3