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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393615391
Report Date: 06/03/2019
Date Signed: 06/03/2019 12:50:38 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
05/24/2019 and conducted by Evaluator Mary Ponce
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20190524175321
FACILITY NAME:BIZZY-BEEZ ACADEMYFACILITY NUMBER:
393615391
ADMINISTRATOR:MARRERO, SHANTELFACILITY TYPE:
850
ADDRESS:500 E. 11TH STREETTELEPHONE:
(209) 834-2223
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:60CENSUS: 39DATE:
06/03/2019
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Alicia NevesTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility failed to confirm proper immunizations for volunteer
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Ponce met with director Shantell Marrero to deliver findings regarding the above allegation. It was alleged that a Volunteer did not have the proper proof of immunization before beginning to volunteer. Based on disclosures made, there is a preponderance of evidence to show that volunteers in the program did not have propery proof of immunizations prior to volunteering in the program; therefore this allegation is SUBSTANTIATED.

Title 22 deficiencies have been cited on the subsequent page of this report. Appeal Rights and Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
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 4
Control Number 53-CC-20190524175321
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: BIZZY-BEEZ ACADEMY
FACILITY NUMBER: 393615391
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
CCR
101216(g)(3)(A)(B)
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Personnel Requirement.The good physical health of each volunteer who works in the center shall be verified by:(A) A statement signed by each volunteer affirming that he/she is in good health.(B) Results of a
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POC: Director stated that before allowing anyone to volunteer in the program, she will require proof of immunizations. Director signed the
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test for tuberculosis performed not more than one year prior to or seven days after initial presence in the center.
This regulation was not met as evidence by volunteer not having proof of immunization prior to volunteering in the program
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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.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 4