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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313625464
Report Date: 03/15/2024
Date Signed: 03/15/2024 09:28:32 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
03/13/2024 and conducted by Evaluator Katrina Owens
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240313134450
FACILITY NAME:GONZALES, YVONNEFACILITY NUMBER:
313625464
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Yvonne Gonzales - LicenseeTIME COMPLETED:
09:35 AM
ALLEGATION(S):
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CRIMINAL RECORD CLEARANCE: Uncleared adult resides in the home.
INVESTIGATION FINDINGS:
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An unannounced inspection was conducted today by Licensing Program Analyst Owens and Perez. LPA's met with licensee Yvonne Gonzales. No day care children were present. Present at time of inspection were licensee, her minor daughter, her daughter's girlfriend and Kenny Walker. The purpose of the inspection was to open and close a complaint investigation. Interviews were conducted.

Based on interviews, licensee admitted that adult male, Kenny Walker, does reside at the home three to four nights a week. The Guardian system shows that Kenny Walker does not have a fingerprint clearance.

The preponderance of evidence standard has been met during this investigation, therefore the above allegation is found to be SUBSTANTIATED. Violations of the California Code of Regulations, Title 22, Division 12 & Chapter 3 are being cited on the attached LIC9099D.

This is a Type A deficiency, hence AB633 Notification Applies: Upon receipt of this report, the report must be posted along with the notice of site visit for 30 days for parents to view. Licensee must inform the parents/guardians of children in care at the facility and to the parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC 9224 Acknowledgement of Receipt of Licensing Reports.

Notice of site visit posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 2
Control Number 03-CC-20240313134450
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: GONZALES, YVONNE
FACILITY NUMBER: 313625464
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2024
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance:
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:
Obtain a California clearance or a criminal record exemption as required by the Department or
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Licensee stated she will have Kenny Walker get live scanned/fingerprinted. She understands that he cannot be at the home until he receives a fingerprint clearance. LPA gave licensee a Livescan form at time
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This requirement was not met as licensee admitted that Kenny Walker resides at the home and he is her boyfriend and Guardian system show he does not have a fingerprint clearance. This is an immediate risk to a child.
Civil Penalties assessed -Type A
citation at time of inspection.
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of inspection. LPA also gave and explained to licensee form LIC 9224 at time of inspection.
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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: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2