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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622164
Report Date: 09/10/2021
Date Signed: 09/10/2021 11:44:26 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
08/25/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210825101741
FACILITY NAME:MATTE, SARAFACILITY NUMBER:
343622164
ADMINISTRATOR:MATTE, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 337-8283
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 6DATE:
09/10/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sara MatteTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee did not isolate herself from day care children while showing symptoms of COVID.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Ferrara conducted a follow up complaint investigation inspection and met with Licensee Sarah Matte. LPA observed six children in care with the Licensee and an assistant. During the investigation, LPA interviewed the Reporting Party, Licensee, one child, and the assistant.
On August 20th, 2021, Licensee did not ensure the personal rights of persons in care to safe and healthful accommodations by not isolating a person who was in the process of being tested for COVID-19 due to exhibiting some symptoms and tested positive on August 21st, 2021.
Based on the information obtained, the allegation is substantiated, meaning the preponderance of evidence standard has been met. See page 9099-D for Type A deficiency cited. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file.
Exit interview was conducted, appeal rights were provided, and a Notice of Site was posted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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-20210825101741
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: MATTE, SARA
FACILITY NUMBER: 343622164
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2021
Section Cited
CCR
102423(a)(2)
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(a) Each child receiving services from a family child care home shall have certain rights…(2) To receive safe, healthful, and comfortable accommodations. This requirement was not met as evidenced by: Licensee did not inform parents of daycare children that a person in the home was in the process of testing for COVID-19.
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Licensee shall write a plan regarding her policy and protocol should anyone at the facility experience symptoms, be testing for Covid, and/or test positive. Licensee shall submit the document to LPA by POC due date.
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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2