573616571-9-8-2021-53-CC-BENN-C6PV5H-20210909160756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 573616571
Report Date: 09/08/2021
Date Signed: 09/08/2021 01:28:33 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
03/24/2021 and conducted by Evaluator Chayntel Hunter

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20210324155223

FACILITY NAME:	NUNEZ, SANDRA		FACILITY NUMBER:	573616571
ADMINISTRATOR:	NUNEZ, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 668-0462
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	14	CENSUS: 1	DATE:	09/08/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Licensee, Sandra Nunez		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Failure to provide a safe environment

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Chayntel Hunter and Fabiola Diaz met with licensee Sandra Nunez to deliver the findings from this complaint investigation. Licensee Nunez is Spanish speaking, and this report was translated to her today.

Investigator Christen Krogstad from the Department’s Investigation Branch (IB) conducted the complaint investigation in conjunction with the Woodland Police Department. The complaint alleged failure to provide a safe environment due to a minor’s inappropriate conduct, which poses a threat to children in care. Investigator Krogstad obtained police records and conducted interviews with current and former daycare children, staff, and individuals who have been affiliated with Minor #1.

Report continues on 9099-C.

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: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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-20210324155223

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: NUNEZ, SANDRA	FACILITY NUMBER: 573616571
	VISIT DATE: 09/08/2021

NARRATIVE

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Disclosures were made during the interviews indicating that Minor #1 touched another minor in an inappropriate manner at the facility. Licensee Nunez denied knowledge of Minor #1 ever acting inappropriately and stated that she does not leave children unattended. Licensee stated that she had removed Minor #1 from the facility. LPAs conducted a tour of the facility and confirmed that Minor#1 was not present at the home.

Based on statements, interviews, and evidence obtained through the investigation, there is a preponderance of evidence to SUBSTANTIATE the above allegation regarding failure to provide a safe environment. The following Title 22 Deficiency is being cited on the subsequent 9099-D pages. Upon receipt of Type A citations, 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 Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 53-CC-20210324155223

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: NUNEZ, SANDRA	FACILITY NUMBER: 573616571
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/09/2021 Section Cited CCR 10243(a)(2)	1 2 3 4 5 6 7	10243 Personal Rights (a) Each child receiving services... shall have certain rights that shall not be waived ... These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee Nunez denied knowledge of Minor # 1 ever acting inappropriately and stated that she does not leave children unattended. Licensee stated that she had removed Minor #1 from the facility on…..
	8 9 10 11 12 13 14	Interviews conducted revealed that Minor #1 had inappropriate interactions with another minor, while at the facility. The Minor’s inappropriate actions poses a threat to children in care. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	Licensee also provided LPAs with a written statment confirming the removal of Minor #1. LPAs cleared the decifiency during the visit.
	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: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

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