343619004-12-20-2019-03-CC-BENN-BK92HG-20191226162442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343619004
Report Date: 12/20/2019
Date Signed: 12/20/2019 12:55:52 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
10/17/2019 and conducted by Evaluator Kristal Goodell

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20191017114303

FACILITY NAME:	DOSS, TONITA		FACILITY NUMBER:	343619004
ADMINISTRATOR:	DOSS, TONITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 333-4332
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95838
CAPACITY:	14	CENSUS: 4	DATE:	12/20/2019
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Tonita Doss		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Allegations:
Supervision: Child was left unattended for an extended period of time.
Fingerprint: Uncleared adult living in the home.

INVESTIGATION FINDINGS:

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LPA Goodell met with licensee Tonita Doss to deliver findings for the above allegations. During today’s visit LPA observed four children present with licensee. Licensee stated no other adults were present. It was alleged that uncleared adults were living in the home. During the investigation, licensee and staff verified adults who work in the facility and reside in the home. LPA also toured all areas of the home including backyard and upstairs. LPA conducted observations, reviewed files and obtained copies of documents related to the complaint allegations. Interviews with children, staff, parents and licensee were also conducted. Based on conflicting information obtained from interviews, documents and observations conducted, LPA was unable to determine uncleared adults live, work in the home or are present with children are in care. It was also alleged that a child was left unattended for extended period of time. During the investigation LPA observed licensee and staff tending to children. Licensee and staff stated children are not left alone indoor or outdoor. LPA was unable to obtain information regarding the incident related to the allegation through interviews with children, staff, parents and licensee. Therefore, LPA was unable to determine if a violation occurred. Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

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-20191017114303

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: DOSS, TONITA	FACILITY NUMBER: 343619004
	VISIT DATE: 12/20/2019

NARRATIVE

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As a result based on the investigation conducted, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are UNSUBSTANTIATED.

No deficiencies cited. Report was reviewed with licensee and copy provided. Appeal Rights also issued and discussed. Notice of Site Visit was issued which must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

LIC9099 (FAS) - (06/04)

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