393616060-8-2-2022-53-CC-JSMH-CGZTZ3-20220805150939

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393616060
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:35:18 PM

Substantiated

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
05/06/2022 and conducted by Evaluator Salene Mayberry

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20220506112615

FACILITY NAME:	ZION CHILD CARE CENTER		FACILITY NUMBER:	393616060
ADMINISTRATOR:	SAWYER, JENNIFER		FACILITY TYPE:	830
ADDRESS:	105 SOUTH HAM LANE		TELEPHONE:	(209) 369-1919
CITY:	LODI	STATE: CA	ZIP CODE:	95242
CAPACITY:	36	CENSUS: 20	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jennifer Sawyer		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff did not provide adequate supervision to child(ren) in care leading to children sustaining injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salene Mayberry met with Director, Jennifer Sawyer to deliver findings of the complaint investigation regarding the above allegation.

During the investigation, LPA observed the facility, conducted interviews, and obtained pertinent information and pictures. It was alleged that staff did not provide adequate supervision to child(ren) in care leading to children sustaining injuries. Records reviewed and staff interviews corroborated that while in care, a child was bitten three times in a single day, and no one could explain how the injuries happened. Based on a preponderance of evidence obtained the complaint regarding the above allegation was SUBSTANTIATED.

A Type A deficiency was cited on the subsequent page (LIC9099-D) of this report.

Report Continued on LIC9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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 53-CC-20220506112615

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: ZION CHILD CARE CENTER	FACILITY NUMBER: 393616060
	VISIT DATE: 08/02/2022

NARRATIVE

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Upon receipt of Type A citations, the Director shall post and provide copies of the LIC9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC9224, Acknowledging Receipt of LIC9099-D in each child's file

An Exit interview was conducted, and the report was reviewed and discussed with Director. Appeal Rights and a copy of the report was printed and provided to the Director. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 53-CC-20220506112615

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: ZION CHILD CARE CENTER	FACILITY NUMBER: 393616060
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 08/12/2022 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without supervision...Supervision shall include visual observation. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director indicated they have created a Behavioral Intervention Plan to help with children biting. In addition, staff will attend a training where supervision and the biting policy will be discussed and signatures of attendees will be provided to Licensing.
	8 9 10 11 12 13 14	On May 5, 2022, a lack of supervision lead to a child being bitten three times in one day. Staff was unable to explain the injuries. This poses and immediate risk to the health and safety of children 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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3