393605588-1-10-2024-53-CC-CHUR-CZL3QD-20240117172657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393605588
Report Date: 01/10/2024
Date Signed: 01/10/2024 11:18:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
12/15/2023 and conducted by Evaluator Tiffanie Diep

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20231215125705

FACILITY NAME:	ROYSTER, JOANNA		FACILITY NUMBER:	393605588
ADMINISTRATOR:	JOANNA ROYSTER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 825-8598
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	14	CENSUS: 5	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	JoAnna Royster		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Other - Licensee did not provide the LIC 995E and LIC 995A to the parent

INVESTIGATION FINDINGS:

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On 01/10/2024 at 9:45 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee JoAnna Royster for the purpose of an unannounced complaint visit to deliver the finding regarding the above allegation. LPA observed five children present in the home with Licensee and their assistant.

It was alleged that Licensee did not provide the Caregiver Background Check Process (LIC 995E) and Notification of Parents’ Rights (LIC 995A) to a parent. Throughout the course of the investigation, LPA made observations at the facility, obtained relevant documents, and conducted interviews with the reporting party, Licensee, and multiple parents.

Continues on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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 53-CC-20231215125705

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ROYSTER, JOANNA	FACILITY NUMBER: 393605588
	VISIT DATE: 01/10/2024

NARRATIVE

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Continued from 9099 (Page 2)

Interviews conducted indicated multiple parents were made aware of both forms at the time of enrollment. Consistent statements disclosed multiple parents were provided copies of both forms from Licensee upon enrollment. Records indicated multiple children’s files contained the bottom portion of the LIC 995A with parent signatures, which acknowledges receipt of both forms. Information obtained revealed a parent was provided with enrollment paperwork prior to the child’s first day of attendance. It was revealed that some of the paperwork, including the LIC 995A, was not fully completed. It was also revealed that paperwork that was both completed and incomplete was maintained at the facility while the child was in care and after care for the child was terminated. It is determined there is a lack of clear corroborating evidence to support the above allegation as acknowledgement of receipt of both forms is only indicated by a signature on the LIC 995A, and there was no other evidence to clearly indicate otherwise.

Based on observations made at the facility, information obtained during interviews, and records reviewed, it is determined that the allegation could not be substantiated or dismissed. Although the allegation might 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 and report was reviewed with the licensee, JoAnna Royster. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie Diep	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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