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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573616993
Report Date: 02/10/2020
Date Signed: 02/10/2020 10:56:45 AM



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
11/06/2019 and conducted by Evaluator Marissa Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20191106153540
FACILITY NAME:PRASAD, TINAFACILITY NUMBER:
573616993
ADMINISTRATOR:PRASAD, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 371-0961
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 10DATE:
02/10/2020
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tina PrasadTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Personal Rights: Child sustained fractured collar bone while in care at the facility
Record keeping: Licensee failed to report an unusual incident report
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marissa Soto and Licensing Program Manager (LPM) Maria Mayorga met with Licensee Tina Prasad to deliver findings for the above allegations. The complaint alleged that child (C1) sustained a fractured collar bone on 10/07/2019 while in care at the facility and that the Licensee did not file an unusual incident report with the Department as required. Upon arrival Licensee Tina Prasad and her assitant were supervising 10 children Ages:( 5 months,1 years old, 1 years old, 2 years old, 2 years old, 3 years old, 3 years old, 3 years old, 4 years old, and 6 years old)
The Department’s Investigation’s Branch conducted the investigation. During the investigation, Investigator Curtis Eichel interviewed the Licensee, her spouse who is also the Licensee’s assistant, parents and several day care children. Investigator Curtis Eichel also obtained and reviewed C1’s medical record pertaining to the injury C1 sustained. The licensee and her assistant stated they were both outside in the back yard with the children when the incident occurred. However, both the licensee and her assistant stated they did not observe what happened or see C1 fall off the play structure upon which C1 had been climbing.
Report continues on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
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 53-CC-20191106153540
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: PRASAD, TINA
FACILITY NUMBER: 573616993
VISIT DATE: 02/10/2020
NARRATIVE
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Prior to falling the Licensee stated C1 had been climbing on the left side of the combination swing-slide set on top of a door on the structure which was not intended to be climbed. The Licensee stated while attending to a child, she heard C1 cry which drew her attention. The Licensee stated she turned around and observed C1 lying on the ground below the play structure with one arm underneath their body. The Licensee stated she observed a scratch and redness on the C1’s face but was unaware any other injuries. The Licensee stated she brought C1 inside, cleaned them, and applied Neosporin to the affected area. The Licensee stated she called C1’s authorized representative and informed them of the incident. The provider failed to provide adequate care to the child as she used the play equipment inappropriately and thus neglected to intervene to prevent serious injury. The Licensee stated she did not report the incident to the Licensing Department because she did not realize she was required to do so. C1’s authorized representative took C1 to the doctor the same evening the incident occurred where the child was examined. It was not until the following the following day that C1 was taken to the doctor a second time due to pain C1 was experiencing when they moved the right arm. When C1 was asked what happened they indicated they had fallen off the play structure. While at the hospital, x-rays were taken of C1 which revealed that C1 had sustained a broken collar bone. Based on the information provided from the interviews, medical report and the providers statement, the preponderance of evidence standard has been met, and it was determined that the above allegations were Substantiated. LPA provided Licensee Tina Prasad with a copy of Title 22, Division 12, Chapter 1 regulations 102416.2 Reporting Requirements, 102423 Personal Rights, and Health and Safety code 1597.467 Injury or acts of violence reporting requirements.
California Code of regulations, Title 22, Division 12 Chapter 3, deficiencies have been cited on the attached LIC 9099D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 9099D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 9099D in each child’s file. A civil penalty determination is pending.
This report was reviewed and discussed with Licensee. A notice of Site Visit and appeal rights were provided.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 53-CC-20191106153540
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: PRASAD, TINA
FACILITY NUMBER: 573616993
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2020
Section Cited
CCR
102423(a)(2)
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Personal Rights: Each child receiving services from a childcare home shall have certain rights that shall not be waived or abridge by the licensee regardless of consent or authorization from the child's authorized reporesentative.These rights include...(2)To receive safe,healthful, and comfortable accommodations,furnishing,and equipment.This requirement is not met as evidence by:
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Licensee understands that she will ensure that there is supervision while chilren are on play equipment, and Licensee will create a written poilcy and will have all staff/adults providing care and supervision sign an acknowlegement of this policy. Proof of written policy will be submitted to the Department by 2/11/2020.
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Based on interviews and medical record review Licensee failed to ensure that child used play equipment safely which led to child sustaining injury. This is an immediate risk to the Health and Safety of 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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20191106153540
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: PRASAD, TINA
FACILITY NUMBER: 573616993
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2020
Section Cited
CCR
102416.2(b)(1)
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Injury or acts of violence reporting requirements:The Licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) that occur during the operation of the family child care home. (reference 1597.467 (b)(1)(C) which states: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.) This requirement is not met as evidenced by:
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Licensee stated that she will ensure that if an unusal incidnet occurs she will contact the department within 24 hours. Licensee will watch a video on reporting requirements, on ccld.childcarevideos.org and will submit written summary by 03/03/2020.
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Based on interviews Licensee did not report the incident to the Department. Which poses a potential Health and Safety risk to the 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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 4