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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 04/15/2022
Date Signed: 04/15/2022 09:59:07 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
03/30/2022 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220330133248
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 9DATE:
04/15/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Briana RomanTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Personal Rights-Staff hit day care child.
INVESTIGATION FINDINGS:
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On Friday, April 15, 2022, Licensing Program Analyst (LPA) Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman conducted a complaint investigation visit and met with Licensee's Assistant, Brianna Roman. The purpose of the inspection visit was to deliver the finding for the above allegation. LPA inspected all areas accessible to children including the off limits areas, took census and conducted observations. Upon arrival to the facility LPA observed one staff member supervising 6 children (2 infants, and four preschool children). Licensee arrived later during the inspection with 3 children (one infant and two school age).

During the course of the investigation, LPA Sierra conducted interviews with children, parents and Licensee. In addition, LPA obtained information pertaining to allegation and observed the care and supervision of the daycare children. It was alleged that staff hit child # 2(C2). Interviews conducted revealed that the Licensee handles children in a rough manner and engaged in inappropriate discipline with the daycare children.

Based on the interviews conducted it was determined that the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D page. ----Report continues on subsuquent page LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
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 5
Control Number 53-CC-20220330133248
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
VISIT DATE: 04/15/2022
NARRATIVE
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Upon receipt of Type A citations, the Licensee shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.

Appeal of Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Ma Natividad Gonzalez.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 53-CC-20220330133248
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: 04/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/18/2022
Section Cited
CCR
102423(a)(4)
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102423 Personal Rights (a) Each child... shall have certain rights that shall not be waived... These rights include... (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation... or other actions of a punitive nature. This requirement was not met as evidenced by:
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This is a repeat violation and civil penalties are being assessed. Licensee stated that her discipline policy is redirection and at times time out. Licensee stated she separate the chidlren if thet are having an issue by grabing them by their waist or arms to moved them to a different area.
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Based on interviews conducted, it was revealed that L1 handles children in a rough manner and has used innappropiate discipline methods with the daycare children. This is an immediate health and safety risk to children in care.
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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 EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/30/2022 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220330133248

FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:558 CHAGALL LNTELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:15CENSUS: 9DATE:
04/15/2022
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Briana RomanTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Personal Rights-Staff did not treat day care children with dignity
Personal Rights-Staff did not provide children with appropriate bedding during overnight care
INVESTIGATION FINDINGS:
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On Friday, April 15 2022, Licensing Program Analyst (LPA) Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman conducted a complaint investigation visit and met with Licensee's Assistant, Briana Roman. The purpose of the inspection visit was to deliver the findings for the above allegations. Upon arrival to the facility LPA observed Licensee's Assistant supervising six children (two infants, and four preschool children). Licensee arrived later during the inspection with 3 more children (one infant and two school age). LPA inspected all areas accessible to children including the off limit areas, took census and conducted observations.

During the course of the investigation, LPA Sierra conducted interviews with children, parents, and Licensee. In addition, LPA obtained information pertaining to the allegations and observed the care and supervision of the daycare children. It was alleged that staff did not treat day care children with dignity and did not provide children with appropriate bedding during overnight care. LPA observed cots, and blankets that are available for the daycare children. Licensee (L1) stated that during overnight care some children sleep in the sofa located in the living room. Sofa converts into a bed. Also L1 provides napping equipment and blankets for the daycare children. Licensee stated she also provides meals to the chidlren and a daily scheduled plan was submitted to Licensing office.
Report continues on subsequent page 9099C--
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20220330133248
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
VISIT DATE: 04/15/2022
NARRATIVE
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Based on the information obtained throughout the investigation the above allegations could not be substantiated or dismissed. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the findings are UNSUBSTANTIATED.

Exit interview was conducted. Appeal rights and Notice of Site Visit was provided to the Licensee, Ma Natividad Gonzalez. Notice of Site Visit should remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5