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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 293624237
Report Date: 11/21/2022
Date Signed: 11/21/2022 12:26:58 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
10/13/2022 and conducted by Evaluator Lea Habtom
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20221013154540
FACILITY NAME:CARMONA, JESSICAFACILITY NUMBER:
293624237
ADMINISTRATOR:CARMONA, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 344-3938
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 5DATE:
11/21/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Jessica CarmonaTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Licensee spanked a child while in care
INVESTIGATION FINDINGS:
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13
On November 21, 2022 Licensing Program Analysts (LPAs) Lea Habtom and Matthew Gallo met with licensee, Jessica Carmona, to deliver the findings of the investigation. Upon arrival, LPAs observed 5 children which consisted of 1 infant and 4 preschool children being supervised by licensee. Licensee's spouse was also present in the home during the inspection.

ALLEGATION: Licensee spanked a `child while in care

During the investigation, LPA Habtom toured the facility, conducted observation and interviewed those pertinent to the investigation. It was alleged that the licensee spanked a child while in care. From interviews, LPA L. Habtom was unable to gather corroborating information to validate that the licensee is spanking children therefore the allegation is found to be UNSUBSTANTAITED. Although it may or may have not happened, there is not a preponderance of evidence to prove that the alleged violations occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022
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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