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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313611358
Report Date: 05/21/2024
Date Signed: 05/21/2024 10:08:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2024 and conducted by Evaluator Lea Habtom
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240412100741
FACILITY NAME:PENA DE LICATA, ROSAFACILITY NUMBER:
313611358
ADMINISTRATOR:PEÑA DE LICATA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 408-7838
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 6DATE:
05/21/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosa Pena De LicataTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Uncleared adult(s) have access to day care children in care
INVESTIGATION FINDINGS:
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On May 21, 2024, Licensing Program Analysts (LPAs) Lea Habtom and Loraine Perez met with licensee, Rosa Pena De Licata, to close a complaint investigation for the above allegation. Upon arrival, LPAs observed 6 children being supervised by the licensee and her assistant. All staff present today have fingerprint clearances and associations.

The complaint alleges uncleared adult(s) have access to day care children. Children and parent interviews revealed that the uncleared adult assisted with caring for the children on multiple occasions. Licensee and reporting party interviews revealed that the uncleared adult assisted with providing care for the children when the licensee’s were out of town with the primary assistant. LPAs observation at the time of opening the complaint was that the uncleared adult was assisting in providing care to the children. Interviews with the licensee disclosed that this uncleared adult was paid for caring for the children for a few days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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 3
Control Number 03-CC-20240412100741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358
VISIT DATE: 05/21/2024
NARRATIVE
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Staff interviews corroborated that the uncleared adult was also paid. Based on the information collected, LPA Habtom gathered that the an uncleared adult had access to day care children therefore the department has found that the allegation to be SUBSTANTIATED: meaning that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 deficiencies were cited on today's inspection on 9099-D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee, Rosa Pena De Licata.

Title 22 Deficiency has been cited on the attached LIC 9099-D. Civil penalty assessed. LPA Lea Habtom informed licensee Rosa Pena De Licata that this report dated May 21, 2024, documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Lea Habtom informed the licensee Rosa Pena De Licata to provide a copy of this licensing report dated May 21, 2024, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Appeal Rights given.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 03-CC-20240412100741
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PENA DE LICATA, ROSA
FACILITY NUMBER: 313611358
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/22/2024
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance 102370(d)(1): All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption
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Licensee received fingerprint clearance for the adult. Citation has been cleared.
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as required by the Department this requirement was not met as evidenced by a paid adult providing assistance to children with no fingerprint clearance which posses an immediate 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.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3