313611421-3-30-2022-03-CC-KPES-CD6MT9-20220404095307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 313611421
Report Date: 03/30/2022
Date Signed: 03/30/2022 10:05:10 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
03/29/2022 and conducted by Evaluator Amanda Blesi

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20220329130052

FACILITY NAME:	BANHAM, MARLENE		FACILITY NUMBER:	313611421
ADMINISTRATOR:	BANHAM, MARLENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 632-9280
CITY:	ROCKLIN	STATE: CA	ZIP CODE:	95677
CAPACITY:	14	CENSUS: 10	DATE:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Marlene Banham		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

PERSONAL RIGHTS: Licensee not following child's dietary needs resulting in day-care child having an allergic reaction.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Amanda Blesi met with licensee Marlene Banham to open the complaint investigation, regarding the above allegation. Upon arrival, LPA observed 10 children supervised by licensee and her assistant Analou Fermin. Licensee states that on March 17, 2022 she accidentally served a four year old child (C1) peanut butter. She served all the children peanut butter but forgot that C1 had a peanut allergy. Licensee immediately called the child's parent who later took the child to the hospital to be evaluated. The child returned to care the next day. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED

Deficiencies are cited on the attached report. See LIC9099-D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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-20220329130052

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: BANHAM, MARLENE	FACILITY NUMBER: 313611421
	VISIT DATE: 03/30/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Amanda Blesi informed licensee Marlene Banham that this report dated 3/30/22 document(s) one 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 Amanda Blesi informed the licensee to provide a copy of this licensing report dated March 30, 2022 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.

Exit interview conducted and report was reviewed with the licensee Marlene Banham. Appeal Rights provided.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 03-CC-20220329130052

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: BANHAM, MARLENE	FACILITY NUMBER: 313611421
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/31/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	PERSONAL RIGHTS: Each child receiving services from a family child care home shall have certain rights that shall not be waived or	1 2 3 4 5 6 7	Licensee states she was in a hurry and was serving all the children peanut butter and forgot that one child had a peanut allergy. She states she will no longer serve peanut butter to any children in her day care and she has joined the food program which has a set menu to follow.
	8 9 10 11 12 13 14	abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidenced by: on 3/17/22, licensee failed to provide a safe envrioment for children in care when she accidentally served a child peanut butter when the child had a peanut allergy. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	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: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3