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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623875
Report Date: 08/30/2023
Date Signed: 08/30/2023 10:00:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO 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
06/13/2023 and conducted by Evaluator Arianna Manabat
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230613092429
FACILITY NAME:4TH R - PASO VERDEFACILITY NUMBER:
343623875
ADMINISTRATOR:GALINDO, JESSICAFACILITY TYPE:
840
ADDRESS:5240 PV SCHOLARS LANETELEPHONE:
(916) 203-2716
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:150CENSUS: DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jessica GalindoTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Supervision:
Due to a lack of supervision, a daycare child is being bullied by another child.
INVESTIGATION FINDINGS:
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On 08/30/2023, at 9:40 AM, Licensing Program Analysts (LPAs), Arianna Manabat and Amanda Sutter, met with Program Coordinator Jessica Galindo to close a complaint. During today's visit, LPAs observed 0 children in care with the Program Director. All individuals subject to a criminal background check have obtained one.

It was alleged that, due to a lack of supervision, a daycare child is being bullied by another child. During the investigation, LPA Manabat obtained relevant documentation, inspected the facility, and interviewed the Directors, Reporting Party (RP), children, and staff. In the information provided to LPA Manabat via the RP, it was stated that children are using inappropriate language and directing that language at the children who are younger than them. RP stated that she learned that older children were asking younger children to engage in inappropriate behavior.
Continued on LIC 9099-C...........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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 3
Control Number 03-CC-20230613092429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: 4TH R - PASO VERDE
FACILITY NUMBER: 343623875
VISIT DATE: 08/30/2023
NARRATIVE
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On a previous visit conducted on 06/16/2023, LPA observed 8 children and a staff on the playground. This staff was sitting at the picnic table on her phone while children continued to play on the structure. Children were running and climbing up the structure, while the staff called the children from where she was sitting. This staff did not make attempts to walk around the play structure or yard area. During this same visit, LPA was able to interview both staff and children about the supervision policy and how it is practiced day to day. LPA found that several children interviewed stated that staff do not pay attention to the children when they are attending the facility. Children and staff stated that staff will congregate in front of the portables and will not take necessary steps to ensure that all children are being supervised to their best ability.

Both children and staff stated that inappropriate language is used by older children and that this is a reoccurring event. Children stated that, because the staff do not properly supervise the children, and are removed from the situation, that these issues are not addressed. Both staff and children stated that when the incidents of foul and inappropriate language is addressed, the actions to rectify the situation are not impactful to the offender or the offended. When LPA asked the staff about the discipline policy, it was stated that the policy, to speak to children about these behaviors, is mainly carried out by the Directors Nick and Jessica.

Finally, LPA Manabat made additional observations on a second visit and documented the perspectives of staff in the area where they area sitting. LPA was unable to hear conversations between children or see over the slide and other play structures. Based on interviews and record reviews, the above allegation was found to be SUBSTANTIATED as it was confirmed, through record review and interviews, that staff did not provide care and supervision as necessary to meet the children's needs. This poses an immediate health and safety risk to children in care. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

Type A acknowledgement forms are to be signed by current parent of the facility and new parents for the next twelve months. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 03-CC-20230613092429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: 4TH R - PASO VERDE
FACILITY NUMBER: 343623875
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2023
Section Cited
CCR
101229(a)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by:
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The Licensee will submit a detailed training plan for all new staff and shall include CPS reporting, visual supervision, and a new disciplinary action plan for offending students.
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Staff did not properly address children's inappropriate behavior due to a lack of supervision which poses an immediate health, safety or personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3