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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 503604250
Report Date: 11/08/2022
Date Signed: 11/08/2022 12:54:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 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
09/12/2022 and conducted by Evaluator Araceli Gibson
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220912141906
FACILITY NAME:ALBERTA MARTONE PREFORMAL CENTERFACILITY NUMBER:
503604250
ADMINISTRATOR:NUNES, HEIDIFACILITY TYPE:
850
ADDRESS:1413 POUST ROADTELEPHONE:
(209) 574-8172
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:24CENSUS: 17DATE:
11/08/2022
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Heidi NunesTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff handled child inappropriately resulting in injury
INVESTIGATION FINDINGS:
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On 11/08/22, Licensing Program Analyst (LPA) Araceli Gibson conducted a complaint inspection at the facility for the purposes of delivering the findings to the above listed allegation. LPA Gibson met with Senior Director Heidi Nunes, ECE Coordinator Kimbra, Draper.

During the course of the investigation, LPA Gibson collected facility records and conducted multiple interviews of witnesses, reporting party, children, parents, and staff. LPA also obtained records from the Modesto City School Human Resources Department.

LPA Gibson investigated the allegation indicating that facility staff caused injury to a day care child on 08/12/22. LPA Gibson observed photos of the injury to the daycare’s child forehead, which showed a raised bump and bruising above the eyebrow. Multiple interviews, self admission by staff and a school reprimand revealed that staff/witness 5 grabbed the child’s foot during play, causing the child to fall and injury herself. There is no indication that staff intentionally caused the child to become injured, but it was deemed to be inappropriate behavior and conduct on behalf of staff.

This agency has investigated the allegation stating that “staff caused injury to day care child” and has determined that the complaint allegation was SUBSTANTIATED, meaning the preponderance of evidence standard has been met.


Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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 4
Control Number 04-CC-20220912141906
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ALBERTA MARTONE PREFORMAL CENTER
FACILITY NUMBER: 503604250
VISIT DATE: 11/08/2022
NARRATIVE
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An exit interview was conducted with Heidi Nunes. Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following TYPE A deficiency was cited today: (see 9099-D). Appeal Rights were provided today. Notice of Site Visit LIC 9213 must be posted for 30 days.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Child Care Parent Notification Requirements a copy of LIC 9224 was given to licensee.
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 04-CC-20220912141906
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ALBERTA MARTONE PREFORMAL CENTER
FACILITY NUMBER: 503604250
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2022
Section Cited
CCR
101223(a)(2)
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Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met based on evidenced of records reviewed, photos and interviews.
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Heidi Nunes, Senior Program Director provided LPA Gibson a copy of the notice of separation for Staff/Witness 5. Staff/Witness 5 is no longer employed with Modesto City Schools.
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LPA Gibson obtained corroborating interviews, photos, and documentation that revealed staff/witness #5 caused an injury to a daycare child. This posed an immediate risk to the health, safety and or personal rights 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: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Araceli GibsonTELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4