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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343620812
Report Date: 06/24/2021
Date Signed: 06/24/2021 12:23:02 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
04/21/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210421160818
FACILITY NAME:BURNS, BREANNAFACILITY NUMBER:
343620812
ADMINISTRATOR:BURNS, BREANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 293-2458
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:14CENSUS: 7DATE:
06/24/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Breanna BurnsTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Lack of supervision led to one child touching another child inappropriately.
INVESTIGATION FINDINGS:
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On Thursday, June 24th, 2021 at 10:30 AM, Licensing Program Analyst (LPA) Kelly Ferrara conducted a follow up complaint investigation inspection and met with Licensee Breanna Burns. LPA verified there were currently seven children in care with the Licensee and two assistants. During the investigation, LPA reviewed relevant documentation and conducted interviews with Reporting Party, Licensee, two parents, two assistants, and one child.
It was alleged that a lack of supervision at the facility led to Child #1 being touched inappropriately by another child in care. During the course of the investigation, it was revealed that the two children involved do not play together and are in the facility only a limited time together. The Licensee stated that she spoke to all of the children in her care regarding keeping distance from each other and no rough housing. LPA observed an action plan that was signed by all staff to prevent incidents from occurring. At the home, LPA observed the assistants and Licensee supervising the children in care actively by moving around with them and interacting.
Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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 2
Control Number 03-CC-20210421160818
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: BURNS, BREANNA
FACILITY NUMBER: 343620812
VISIT DATE: 06/24/2021
NARRATIVE
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Based on the evidence obtained during the investigation, the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it. A copy of this report was given to the Licensee and a Notice of Site was provided. Licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2