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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393620802
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:28:26 PM

Unsubstantiated


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
03/27/2023 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230327160428
FACILITY NAME:CAPC - DIABLO HOMESFACILITY NUMBER:
393620802
ADMINISTRATOR:KRISTINA KUMARFACILITY TYPE:
850
ADDRESS:340 WEST FOURTH STTELEPHONE:
(209) 464-4524
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:44CENSUS: 7DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Vanessa BuenoTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Day care children sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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** This is an amended report **
On May 24, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Vanessa Bueno for the purpose of delivering complaint findings. LPA observed seven children supervised by two staff.

LPA Williams conducted an investigation regarding the complaint allegation listed above. The facility was toured, and interviews were conducted with the reporting party (RP) facility staff, and children in care. Additional pertinent information was received to assist with the investigation. It was alleged that C1 sustained an unexplained injury while in care at the facility.

Facility staff was interviewed and reported that C1 came to school with their neck tilted while holding their ear and was not their usual self in the morning. C1 was monitored which included their temperature being taken as a precautionary measure for illness. It was determined that C1 had a mild temperature which initiated an early dismissal from school. RP suggested that an injury may have occurred from C1 falling off the playground slide. Staff denied any injury occurred for C1 while in care. Interviews conducted with staff in addition to a review of the daily activity schedule indicated that outdoor time did not occur prior to C1 leaving the facility due to illness.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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 4
Control Number 53-CC-20230327160428
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: CAPC - DIABLO HOMES
FACILITY NUMBER: 393620802
VISIT DATE: 05/24/2023
NARRATIVE
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**This is an amended report **
Inconsistent statements were received from children interviewed. Based on the information received, the allegation is determined to be unsubstantiated. 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.

Exit interview conducted at which time the report was reviewed with Facility Representative, Vanessa Bueno. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4