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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573622056
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:17:16 PM

Unsubstantiated


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
04/08/2022 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220408082806
FACILITY NAME:ESCAMILLA, DONITAFACILITY NUMBER:
573622056
ADMINISTRATOR:ESCAMILLA, DONITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 921-6498
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 8DATE:
04/21/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Donita EscamillaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Day care child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chayntel Hunter and Lauren Scott met with Licensee, Donita Escamilla to deliver the findings of the complaint investigation regarding the above allegation.

During the course of the investigation, LPA Hunter conducted interviews, and obtained information pertaining to the above allegations. It was alleged that children sustained unexplained injuries while in care. During interviews conducted, LPA received conflicting information and was unable to determine if the injuries occurred at the facility. Based on the conflicting information obtained throughout the course of this investigation the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED. Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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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