394500171-9-20-2021-53-CC-BENN-C8WPRL-20211119103252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 09/20/2021
Date Signed: 09/20/2021 05:01:31 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
09/15/2021 and conducted by Evaluator Chayntel Hunter

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20210915152632

FACILITY NAME:	GONZALEZ, MA NATIVIDAD		FACILITY NUMBER:	394500171
ADMINISTRATOR:	GARCIA, NATIVIDAD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 642-3525
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 12	DATE:	09/20/2021
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Licensee, Ma Natividad Gonzalez		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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daycare children allowed in off limits area.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Licensee, Ma Natividad Gonzalez to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPAs conducted interviews, and obtained information pertaining to the allegation. It was alleged that daycare children are allowed in off limits areas. During LPA interviews, a description of the off limits area was provided. During a tour of the off limits area, with the Licensee, it was determined that the description of the room matched the layout. Licensee stated children do not access the off limits areas, but will have a discussion with staff to ensure compliance is maintained. Based on the interviews and LPAs observation of the off limits area, it was determined that children are allowed in off limits areas. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Title 22 regulations are being cited on the attached 9099-D page. An exit interview was conducted with the Licensee. Appeal rights were printed and provided. Notice of Site Visit was provided and should remain posted for 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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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Control Number 53-CC-20210915152632

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: GONZALEZ, MA NATIVIDAD	FACILITY NUMBER: 394500171
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/29/2021 Section Cited CCR 102416.3(a)(6)	1 2 3 4 5 6 7	102416.3 Alterations to Existing Buildings or Grounds (a) Prior to making alterations or additions to a family child care home... the licensee shall notify the Department.... (6) Any change from an area of the family child care home previously identified as "off limits" ... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated she was not aware that children have been in an off limits areas. Licensee stated she will talk to staff to ensure that compliance is maintained in regards to off limits areas in the home. LPAs cleared the deficiency during the visit.
	8 9 10 11 12 13 14	Based on interviews conducted and LPA observations, it was determined that children are allowed in an off limits area. This is a potential health and safety risk to 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: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC9099 (FAS) - (06/04)

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