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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503604009
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:10:16 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2021 and conducted by Evaluator Rene Mancinas
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210722083804
FACILITY NAME:CCCDS - STONUM CHILD DEVELOPMENT CENTERFACILITY NUMBER:
503604009
ADMINISTRATOR:CAMBRIA RIVASFACILITY TYPE:
850
ADDRESS:1336 STONUM ROADTELEPHONE:
(209) 581-9180
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:42CENSUS: 29DATE:
09/29/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cambria RivasTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Day care child injured another day care child.
INVESTIGATION FINDINGS:
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On 09/29/2021 Licensing Program Analysts (LPAs) Rene Mancinas JR and Kari McWilliams conducted an unannounced inspection to provide finding regarding the above allegation. LPAs met with Site Supervisor, Cambria Rivas. LPA Mancinas explained and discussed the above allegation and finding with Cambria.

During the course of the investigation, LPA Mancinas interviewed staff, reviewed and obtained facility records, and reviewed local law enforcement information associated to this complaint. The investigation revealed that a child did sustain an injury involving children safety scissors. The incident occurred while adequate staff were supervising children, and while maintaining proper supervision and teacher-to-child ratios, as required per regulations.

(Continued 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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 04-CC-20210722083804
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CCCDS - STONUM CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 503604009
VISIT DATE: 09/29/2021
NARRATIVE
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Although the above allegation that a child sustained an injury did occur, the preponderance of evidence standard was not met to suggest the injury happened as a result of child(ren) having access to adult scissors (as reported), or as a result of lack of supervision or teacher-to-child ratio concerns. Therefore, the above allegation is UNSUBSTANTIATED.

Per California Code of Regulations Title 22 Division 12 Chapter 1 no deficiencies are being cited. Notice of Site to be posted for 30 days.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2