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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343621704
Report Date: 02/23/2021
Date Signed: 02/24/2021 09:22:21 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
12/03/2020 and conducted by Evaluator Socorro Kelly
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20201203144021
FACILITY NAME:ALVAREZ, JESSICAFACILITY NUMBER:
343621704
ADMINISTRATOR:ALVAREZ, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 671-9104
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:14CENSUS: 5DATE:
02/23/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Jessica AlvarezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Adult in the home plays with daycare child in a rough manner.
INVESTIGATION FINDINGS:
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LPA Kelly met with licensee on 2/23/21 at 9:40pm via Facetime due to COVID, to inform her of the complaint allegation findindg. There were 5 day care children present.

LPA Kelly conducted the investigation regarding the allegation that someone in the home played with daycare child in a rough manner. LPA obtainted evidence in a video recording displaying an individual, (not a day care child) engaging in unwanted water play with a child, spraying the child in the face with a water hose as child was trying to get away, therefore this allegation is deem Substantiated.

Type A citation was assessed for Personal Rights
Appeal Rights was provided

(Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child’s file upon receipt from parent.)

TRANSLATION FOR LICENSEE:
(Una vez recibido, la proveedora de la licencia publicará esta informacion puesto en la pared por 30 diaz. Proporcionará copias de este informe de licencia a los padres / tutores de los niños bajo cuidado en el programa y a los padres / tutores de los niños recién inscritos en su programa durante los próximos 12 meses.)
Los padres o tutores deben reconocer recibo de este informe y la citación firmando una LIC 9224, “RECONOCIMIENTO DE RECIBO DE INFORMES DE LICENCIA”. Se debe colocar una copia de este formulario en el archivo de cada niño al recibirlo de los padres.


A copy of this report was provided to director via email to be signed and return to LPA.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021
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 3
Control Number 03-CC-20201203144021
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: ALVAREZ, JESSICA
FACILITY NUMBER: 343621704
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2021
Section Cited
HSC
102423(1)
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102423 Personal Rights(1) To be treated with dignity in his/her personal relationship with staff and other persons.
An individual (not a daycare child) at the daycare engaged in unwanted water play with child, spraying the child in the face while child was trying to get away.
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Licensee stated I just want to apologize for what happened to the child in my care, I will pay more attention when children are engaging in play, give my helpers and my own children more training about respecting children dignity, I will be more attentive when children are playing, talk to them to respect for each other and to not engage in inappropriate play.
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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) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
12/03/2020 and conducted by Evaluator Socorro Kelly
COMPLAINT CONTROL NUMBER: 03-CC-20201203144021

FACILITY NAME:ALVAREZ, JESSICAFACILITY NUMBER:
343621704
ADMINISTRATOR:ALVAREZ, JESSICAFACILITY TYPE:
810
ADDRESS:7267 SALAZAR DRIVETELEPHONE:
(916) 671-9104
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:14CENSUS: 5DATE:
02/23/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Jessica AlvarezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Lack of supervision
INVESTIGATION FINDINGS:
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LPA Kelly met with licensee on on 2/22/21 at 4:33pm and again on 2/23/21 at 9:40am via Facetime due to COVID, to inform and discuss with her the complaint allegation finding. There were 5 day care children present.

During the course of the complaint investigation, LPA interviewed licensee, parents, licensee's assistant/daughter, child and collected documentation. LPA dismissed the allegations that there was lack of supervision resulting in day care children engaging in inappropriate activity and that a minor was providing care and supervision to day care children. LPA did not uncovered any evidence or compelling information through the interviews to support that these activities occurred in the home, therefore, the allegation are deemed Unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited.

Appeal Rights were provided

This report and paperwork were provided to the licensee via email to be signed and return.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro KellyTELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3