343622386-6-4-2019-03-CC-BENN-BDPLGB-20190702084426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343622386
Report Date: 06/04/2019
Date Signed: 06/04/2019 01:58:07 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
04/17/2019 and conducted by Evaluator Socorro Kelly

COMPLAINT CONTROL NUMBER: 03-CC-20190417145012

FACILITY NAME:	WITTE SAINZ, CARMEN		FACILITY NUMBER:	343622386
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	06/04/2019
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Carmen Sainz Witte		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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9

Caregiver left daycare children unsupervised.

INVESTIGATION FINDINGS:

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LPA Kelly met with licensee and her assistant to inform them of the complaint allegation finding. LPA inspected the home and observed 2 two year old day care children.

During the course of the investigation, LPA conducted interviews of staff, children, witnesses and collected law enforcement documentation/report. Based on the evidence collected through these interviews which revealed that child #1 and child #2 were left without supervision for a period of time while they were playing at the park.

Civil Penalty and Type A deficiency were assessed. Appeal rights were provided.

Based on LPA observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation( found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)

Deficiencies are cited on the subsequent pages of this report under the California Code of Regulations, Title 22.
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. The LIC 9224 may be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the licensee.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro Kelly	TELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

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-20190417145012

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: WITTE SAINZ, CARMEN	FACILITY NUMBER: 343622386
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/04/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/05/2019 Section Cited HSC 102417(a)	1 2 3 4 5 6 7	The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absense. During interviews, it was revealed that licensee's assistant left 2 day care child without supervision for a period of time whilevvisiting a neighborhood park.	1 2 3 4 5 6 7	Licensee and her assistant stated that from this day forward, taking the children to the park or any other location while day care children are attending day care will sease.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Socorro Kelly	TELEPHONE: (916)216-7792
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

LIC9099 (FAS) - (06/04)

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