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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393622066
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:03:14 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
08/08/2022 and conducted by Evaluator Mariya Melnichuk
COMPLAINT CONTROL NUMBER: 53-CC-20220808164501
FACILITY NAME:HILL, SUSANFACILITY NUMBER:
393622066
ADMINISTRATOR:HILL, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 967-8394
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:14CENSUS: DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Personal Rights: Child sustained injury while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mariya Melnichuk ad Lisensing Progrm Manager (LPM) Bettina Engleman met with Licensee, Susan Hill to deliver the findings of the complaint investigation regarding the above allegation.
During the course of the investigation, LPA Melnichuk conducted interviews, and obtained information pertaining to allegation. It was alleged that a child sustained injuries while in care. Interviews were conducted and revealed that a child was hurt during care when the licensee temporarily stepped out of the playroom. However, the licensee took care of the incident and reported the injury to the parents immediately. Interviews revealed that the licensee is responsive to children in care and parents feel that their child is safe in the facility.

Report continues on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Mariya MelnichukTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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 2
Control Number 53-CC-20220808164501
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: HILL, SUSAN
FACILITY NUMBER: 393622066
VISIT DATE: 11/03/2022
NARRATIVE
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Based on the information obtained throughout the course of this investigation the above allegations could not be substantiated or dismissed. While the child got injured, it could not be determined that the injury was due to a personal rights violation. 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, therefore the finding is UNSUBSTANTIATED.

Exit interview was conducted. 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: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Mariya MelnichukTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2