343620090-1-7-2021-03-CC-KPES-BX8NCU-20210113092116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343620090
Report Date: 01/07/2021
Date Signed: 01/07/2021 01:53:11 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
12/15/2020 and conducted by Evaluator Lea Habtom

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20201215115133

FACILITY NAME:	HENDERSON, JANINA C.		FACILITY NUMBER:	343620090
ADMINISTRATOR:	HENDERSON, JANINA C.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 849-8040
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95621
CAPACITY:	14	CENSUS: 11	DATE:	01/07/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Janina Henderson		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Record keeping: Licensee did not notify responsible party of child's injury

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Due to COVID-19 Licensing Program Analyst (LPA) Lea Habtom Habtom was unable to close the complaint based on normal practice of an unannounced inspection. LPA Habtom conducted a tele-visit using facetime on January 7, 2021 at 1:00 pm with the licensee Janina Henderson. The census at the time of the inspection was 11 children supervised by licensee and staff member Keira Richardson.

Record keeping: Licensee did not notify responsible party of child's injury
During the investigation, LPA Habtom toured the facility, conducted observation and interviewed those pertinent to the investigation. It was alleged that the licensee did not notify the responsible party of the child’s injury. Interviews with the reporting party as well as the licensee indicated that the responsible party was not notified by pick up and was made aware of the incident from the child.

Report continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021

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 4

Control Number 03-CC-20201215115133

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: HENDERSON, JANINA C.	FACILITY NUMBER: 343620090
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/12/2021 Section Cited CCR 102416.2(f)(1)	1 2 3 4 5 6 7	102416.2(f)(1) Reporting requirements: As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child...Any injury suffered by a child in care shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional.	1 2 3 4 5 6 7	Licensee agreed to notifying the enrolling parent at pick up of the incident. Licensee will also be updating the parent handbook to reflect this change. Plan of correction was made when child was picked up at the end of the end and reporting party sent text to licensee regarding the incident. Licensee agreed to having a discussion with the reporting party and child.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by interviews from licensee and reporting party indicating that the incident was not notified to the reporting party by pick up. This is a potential risk to the health and safety of 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: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 03-CC-20201215115133

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: HENDERSON, JANINA C.	FACILITY NUMBER: 343620090
	VISIT DATE: 01/07/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The responsible party then addressed the situation with the licensee who agreed to discussing the incident. LPA Habtom determined that the responsibility party was not notified of the incident therefore the allegation the licensee did not notify the responsible party of the child’s injury to be substantiated.

Title 22 deficiencies are cited on the attached LIC 9099-D. Notice of Site Visit provided. Appeal Rights Provided. Licensing report was reviewed and discussed with licensee.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea Habtom	TELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4