343623767-4-22-2021-03-CC-KPES-C2QS6N-20210505133613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343623767
Report Date: 04/21/2021
Date Signed: 04/22/2021 03:21:32 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
02/19/2021 and conducted by Evaluator Rosie Pitts

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20210219084835

FACILITY NAME:	PARKER, MARK		FACILITY NUMBER:	343623767
ADMINISTRATOR:	PARKER, MARK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(219) 384-1228
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	14	CENSUS: 8	DATE:	04/21/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Mark Parker		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Other: Licensee does not live in the home

INVESTIGATION FINDINGS:

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Due to COVID-19 pandemic social distancing guidelines, a televisit was conducted.
Licensing Program Analyst (LPA) Rosie Pitts called Licensee and staff #1 for the purpose of closing the complaint allegation mentioned above. Staff #1 called back. . LPA observed 8 children being supervised by Staff #1. Staff #2 and #3 were in the kitchen cooking. Several minutes into the visit, LPA observed Licensee sitting in a chair outside.
Throughout the course of the investigation LPA learned through interviews conducted that majority parents did not mention Mark as their child's DayCare provider. Children interviewed also did not mention Mark as their caregiver. During 1 televisit When asked for the children's names in care, Mark stated that he did not know their names, however Staff #1 did know them. During 2 separate phone calls, Licensee provided conflicting information regarding being at the facility and initially refused to participate in a teleinspection.
Report continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

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-20210219084835

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: PARKER, MARK	FACILITY NUMBER: 343623767
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/28/2021 Section Cited HSC 1596.78(a)	1 2 3 4 5 6 7	"Family day care home" means a home that regularly provides care, protection, and supervision for 14 or fewer children, in the provider's own home...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated that he does live in the home and will appeal.A statement from Licensee in writing and additional proof of residency is to be provided
	8 9 10 11 12 13 14	Based on observations and interviews LPA obtained information that supports the allegation that Licesee does not live in the home., which poses a potential health and safety risk to tchildren in care	8 9 10 11 12 13 14
	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: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

LIC9099 (FAS) - (06/04)

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Control Number 03-CC-20210219084835

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: PARKER, MARK	FACILITY NUMBER: 343623767
	VISIT DATE: 04/21/2021

NARRATIVE

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During an additional tele-inspection, Licensee was not present in the home and arrived after he was notified by an associated individual present in the home. Furthermore, LPA obtained corroborating information through interviews that the licensee does not live in the home. Individuals listed as licensee must live in the home and be present at the facility eighty percent of the time. Licensee stated that he does live in the home.
Based on observations, interviews conducted, and information obtained, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED.
Title 22 deficiencies were cited and must be corrected by the due date. Appeals rights were discussed and issued. An exit interview was conducted in which the report was reviewed and discussed with licensee. Upon receipt of this report, the report must be posted for 30 days for parents to view.
In lieu of Licensee's signature, LPA Pitts is e-mailing the report and Licensee will respond via email as verification of receipt.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

LIC9099 (FAS) - (06/04)

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