573615569-10-4-2022-53-CC-BENN-CJWR2N-20221005123837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 573615569
Report Date: 10/04/2022
Date Signed: 10/04/2022 10:16:01 AM

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
07/01/2022 and conducted by Evaluator Salene Mayberry

COMPLAINT CONTROL NUMBER: 53-CC-20220701084335

FACILITY NAME:	MACNEAR, JACQUELINE		FACILITY NUMBER:	573615569
ADMINISTRATOR:	MACNEAR, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 400-3517
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY:	14	CENSUS: 0	DATE:	10/04/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Jacqueline MacNear		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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1. Facility staff failed to seek timely medical attention for child injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salene Mayberry met with Licensee, Jacqueline MacNear to deliver findings of the complaint investigation regarding the above allegation.

Investigator Sergio Guerra from the Department’s Investigation Branch conducted the complaint investigation. It was alleged that “facility staff failed to seek timely medical attention for child injury”. Investigator Guerra obtained medical records and conducted interviews with staff, families in care and medical personnel. Interviews revealed that emergency services were never contacted, and that Licensee and a second staff member were called prior to a parent of the injured child being contacted for an injury requiring immediate medical attention.

Report continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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-20220701084335

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: MACNEAR, JACQUELINE	FACILITY NUMBER: 573615569
	VISIT DATE: 10/04/2022

NARRATIVE

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Based on a preponderance of evidence obtained the complaint regarding the above allegation was SUBSTANTIATED.

A Type A deficiency was cited on the subsequent page of this report (LIC9099-D) .

Upon receipt of Type A citations, Licensee shall post and provide copies of the LIC9099-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 LIC9224, Acknowledging Receipt of LIC9099-D in each child's file

An Exit interview was conducted, and the report was reviewed with Licensee. Appeal Rights and a copy of the report were printed and provided to Licensee. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. A failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 53-CC-20220701084335

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: MACNEAR, JACQUELINE	FACILITY NUMBER: 573615569
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/04/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423 Personal Rights (a) Each child receiving services...shall have certain rights that shall not be waived...by the licensee…These rights include..: (2) To receive safe, healthful, and comfortable accommodations...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	License has stoped providing care as of 8/26/22, released all of her staff and has requested in writing that the Community Care Licensing Department close her license.
	8 9 10 11 12 13 14	On June 29, 2022, staff failed to notify emergency services, and then called two other staff members prior to contacting the parents of an injury in care which required immediate medical attention. This poses and immediate risk to the health and safety of 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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene Mayberry	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC9099 (FAS) - (06/04)

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