343623177-11-8-2022-03-CC-RSAA-CLUMVS-20221206085714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343623177
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:10:52 PM

Unsubstantiated

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
10/14/2022 and conducted by Evaluator Fabiola Diaz

COMPLAINT CONTROL NUMBER: 03-CC-20221014140716

FACILITY NAME:	MINEAR, KATRINA		FACILITY NUMBER:	343623177
ADMINISTRATOR:	MINEAR, KATRINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 531-2558
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 10	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Katrina Minear		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Daycare infant sustained injuries while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Fabiola Diaz and Corina Beckby arrived at the facility at approximately 1:55 pm and met with licensee Katrina Minear to close a complaint investigation, regarding the above allegation. Upon arrival, LPAs observed 10 day care children and 2 adult assistants. During the investigation LPA Diaz made observations, conducted interviews, and gathered documents pertaining to the investigation. It was alleged infant sustained an injury on the tongue while in care. Licensee explained that licensee did not observe any injuries on infant’s tongue before infant left the facility, and licensee did not observe any incident involving infant at facility. Staff interviews did not disclose concerns about the infant in care, nor about the facility. Parent interviews disclosed no concerns with the facility, discipline policy, nor incidents at the facility. 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, therefore the allegation is Unsubstantiated.
An Exit Interview was conducted in which the report was reviewed and discussed with Licensee. A copy of this report was provided to the Licensee. A Notice of Site Visit and Appeal Rights were provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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 1