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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393615641
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:10:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
07/03/2023 and conducted by Evaluator Carla Polanco Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230703111817
FACILITY NAME:TABORA, JACQUELINEFACILITY NUMBER:
393615641
ADMINISTRATOR:TABORA, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 623-6116
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 2DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Licensee Jacqueline TaboraTIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
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8
9
Personal rights: Staff did not use appropriate form of discipline
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/22/23, Licensing Program Analyst Carla Polanco (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA met with Licensee, Jacqueline Tabora. Throughout the course of the investigation LPA conducted observations, interviews, and reviewed and collected documents.

It was alleged that staff used an innappropriate form of discipline with a daycare child. Interviews conducted with staff, parents and children revealed that the facility does not take part in physical discipline of children. In addition, parents interviwed stated that the provider notifies them if there is a concern over a child's behavior.

Based on the interviews conducted, and the records reviewed, the above allegation was found to be UNSUBSTANTIATED, meaning that 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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