343621637-7-10-2023-03-CC-ABLI-CTQQMQ-20230714121756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343621637
Report Date: 07/10/2023
Date Signed: 07/10/2023 09:38:39 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2023 and conducted by Evaluator Arianna Manabat

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20230425095151

FACILITY NAME:	PIERCE, TIFFANY		FACILITY NUMBER:	343621637
ADMINISTRATOR:	PIERCE, TIFFANY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 743-0397
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95833
CAPACITY:	14	CENSUS: 8	DATE:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tiffany Pierce		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Child in care sustained unexplained injuries

INVESTIGATION FINDINGS:

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On 07/10/2023 at approximately 9:15 AM, Licensing Program Analysts (LPAs) Arianna Manabat and Kyrsten Williams met with Licensee Tiffany Pierce to deliver findings for the allegation mentioned above. During today's visit, LPAs observed seven children in care being supervised by the Licensee and her husband. It was alleged that child in care sustained unexplained injuries. Through observations, interviews, and record review, LPA Manabat was unable to obtain enough evidence or documentation that the child sustained the injuries in care.
During interviews with the Licensee and children, it was stated that discipline does not involve any form of corporal punishment. Upon review of interviews, LPA has found conflicting statments from both the Reporting Party (RP), children, and Licensees pertaining to the allegation.

CONTINUED ON LIC 9099-C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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-20230425095151

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PIERCE, TIFFANY	FACILITY NUMBER: 343621637
	VISIT DATE: 07/10/2023

NARRATIVE

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CONTINUED FROM LIC9099....
Due to conflicting information and a lack of evidence pertaining to the allegation, LPA has determined the complaint to be UNSUBSTANTIATED, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove it. An exit interview was conducted and a Notice of site visit and appeal rights were assessed. The Notice of site visit shall remain posted for 30 days for guardian/parental review.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

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