<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343617614
Report Date: 08/06/2024
Date Signed: 08/06/2024 01:45:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
05/22/2024 and conducted by Evaluator Corina Beckby
COMPLAINT CONTROL NUMBER: 53-CC-20240522094514
FACILITY NAME:CHAMPIONS @ CARROLL ELEMENTARYFACILITY NUMBER:
343617614
ADMINISTRATOR:DONYEALL ROBINSONFACILITY TYPE:
850
ADDRESS:10325 STATHOS DRIVETELEPHONE:
(916) 714-4362
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:21CENSUS: 15DATE:
08/06/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Donyeall RobinsonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of Supervison: Staff left child unattended in the bathroom
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/06/24, Licensing Program Analyst (LPA) Corina Beckby conducted an unannounced complaint investigation to deliver the findings for the above allegation. LPA met with Site Director, Donyeall Robinson. Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, and conducted interviews. LPA reviewed and collected documentation pertaining to the allegations.

It was alleged that a child was left unattended in the bathroom. LPA observed 4 different occasions when children used the bathroom without teacher supervision.
Based on observations conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Continued on LIC 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
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 5
Control Number 53-CC-20240522094514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CHAMPIONS @ CARROLL ELEMENTARY
FACILITY NUMBER: 343617614
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2024
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
LPA provided Technical Support Program brochure and Supervision in Center video on department website. Director will have staff watch videos, have staff training/meeting regarding
8
9
10
11
12
13
14
LPA witnessed 4 different occasions when children went to the bathroom on their own, unattended by a teacher.
8
9
10
11
12
13
14
supervision, and develop a plan of action to prevent occurance. Direcor wil have staff sign, saying they watched the videos and understand the importance of supervision.
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.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
05/22/2024 and conducted by Evaluator Corina Beckby
COMPLAINT CONTROL NUMBER: 53-CC-20240522094514

FACILITY NAME:CHAMPIONS @ CARROLL ELEMENTARYFACILITY NUMBER:
343617614
ADMINISTRATOR:DONYEALL ROBINSONFACILITY TYPE:
850
ADDRESS:10325 STATHOS DRIVETELEPHONE:
(916) 714-4362
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:21CENSUS: 15DATE:
08/06/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Donyeall RobinsonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff are not assisting the child in the bathroom
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/06/24, Licensing Program Analyst (LPA) Corina Beckby conducted an unannounced complaint investigation to deliver the findings for the above allegation. LPA met with Site Director, Donyeall Robinson. Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, and conducted interviews. LPA reviewed and collected documentation pertaining to the allegations.

It was alleged that staff are not assisting child in the bathroom. Parents interviewed do not have concerns regarding the care of the children. Through staff interviews, parents are informed at orientation, that children must be potty-learned and use the bathroom

Continued on LIC 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20240522094514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CHAMPIONS @ CARROLL ELEMENTARY
FACILITY NUMBER: 343617614
VISIT DATE: 08/06/2024
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
page 2...

on their own. If a child needs assistance, the staff will encourage and demonstrate how to clean themselves but will not physically touch a child. If necessary, a parent will be called to pick up or change a child, if a child soils themselves or clothes. Enrollment flyers state in writing that children must be able to use the bathroom without assistance.

Based on lack of clear corroborating evidence, the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the finding is UNSUBSTANTIATED.

An exit interview was conducted in which the report was reviewed and discussed with the Site Director, Donyeall Robinson. LPA provided a copy of the report and Appeal Rights to Site Director. A Notice of Site Visit was posted by LPA and Site Director understands it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 53-CC-20240522094514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CHAMPIONS @ CARROLL ELEMENTARY
FACILITY NUMBER: 343617614
VISIT DATE: 08/06/2024
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
page 2...

LPA informed Site Director, Donyeall Robinson, that this report dated 08/06/2024, documents a Type A citation that is an immediate Health and Safety, or Personal Rights risk to persons in care. An 809D is issued for the deficiency. Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and Licensee will obtain a signed Acknowledgment of Licensing Reports (LIC9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An Exit interview was conducted, and the report was reviewed with Site Director, Donyeall Robinson. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5