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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 340306392
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:09:37 PM

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
11/13/2024 and conducted by Evaluator Amanda Sutter
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20241113125543
FACILITY NAME:ASSOCIATED STUDENTS CSUS CHILDREN'S CENTERFACILITY NUMBER:
340306392
ADMINISTRATOR:VELTE, SHERRYFACILITY TYPE:
850
ADDRESS:6000 J STREETTELEPHONE:
(916) 278-6216
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:126CENSUS: 62DATE:
01/29/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sherry VelteTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not provide incident reports to day care child's responsible party.
INVESTIGATION FINDINGS:
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On Wednesday, January 29, 2025, Licensing Program Analysts (LPAs) Amanda Sutter and Kyrsten Williams met with Director Sherry Velte to deliver findings regarding the above allegations. LPAs observed 62 children supervised by 18 staff. It was alleged that staff do not provide incident reports to day care child's responsible party.

LPA Sutter conducted interviews and gathered documentation of the investigation. On November 21, 2024, Director submitted an Unusual Incident Report (UIR) stating that a child was served a snack item on 11/18/2024 that he was allergic to. The child had a physical reaction that required medical attention. Director stated that child's Teacher did not immediately notify the child’s parent. LPA learned that the parent was notified at pick up by another staff person. No incident report was provided at pick up, but was written by the teacher on 11/19/2024.

CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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-20241113125543
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: ASSOCIATED STUDENTS CSUS CHILDREN'S CENTER
FACILITY NUMBER: 340306392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2025
Section Cited
CCR
101212(f)
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101212 Reporting Requirements (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

This regulation was not evidenced by:
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Director will conduct a training with staff to review reporting requirements. Staff will sign a verification memo, which will be provided to LPA by date listed.
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Based on interview and record review, an incident that required medical care was not reported to a parent, which posed a potential Health, Safety, or Personal Rights risk to persons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20241113125543
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: ASSOCIATED STUDENTS CSUS CHILDREN'S CENTER
FACILITY NUMBER: 340306392
VISIT DATE: 01/29/2025
NARRATIVE
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Based on the evidence obtained, LPAs determined that the allegation is substantiated, meaning that the preponderance of evidence standard has been met. One Type B citation was issued on the following 9099-D. Exit interview was conducted. A copy of this report was given to Licensee Representative Sherry Velte. Appeal rights were provided.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3