<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622373
Report Date: 10/18/2024
Date Signed: 10/18/2024 12:56:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
08/13/2024 and conducted by Evaluator Jennie Tedlos
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240813115106
FACILITY NAME:GODINEZ, JUANITAFACILITY NUMBER:
343622373
ADMINISTRATOR:GODINEZ, JUANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 230-6190
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 10DATE:
10/18/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Juanita GodinezTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is operating beyond the terms and conditions of the license.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 18, 2024, Licensing Program Analyst (LPA) Jennie Tedlos met with Licensee, Juanita Godinez, to deliver the findings of the complaint investigation regarding the above allegation. LPA observed 10 children.

LPA Tedlos conducted an investigation regarding the complaint allegation listed above. LPA toured the facility, conducted interviews with the Staff Members, Children enrolled at the facility and parents of children that attend or who have attended the facility. LPA also obtained pertinent information to assist with the investigation.

It was alleged that the Licensee was operating beyond the terms and conditions of the license. There was concern for ratio and an unqualified assistant. The Licensee provided LPA with the facility roster and provided documentation and files of the assistants at the facility. The Licensee states that there are two assistants... Report continues on 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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 53-CC-20240813115106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GODINEZ, JUANITA
FACILITY NUMBER: 343622373
VISIT DATE: 10/18/2024
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
...that help with ratio and at least 1 assistant is present every day. During the course of the investigation, LPA conducted observations and document review. During each observation, LPA observed a ratio that was compliant with regulations. LPA conducted document review and found that the assistants' documentation was compliant with regulations. Record review, interviews with parents, children, and staff, and LPA observation did not support the allegation.

Based on the interviews conducted, and the records reviewed, the above allegation was found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted by LPA Jennie Tedlos with Licensee Juanita Godinez, and Appeal Rights were provided. A Notice of Site Visit was posted by LPA and shall remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2