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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619102
Report Date: 10/27/2021
Date Signed: 10/27/2021 03:10:44 PM

Substantiated


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
05/03/2021 and conducted by Evaluator Jeevun Birk
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210503133505
FACILITY NAME:ALEXANDER, PATRICIAFACILITY NUMBER:
343619102
ADMINISTRATOR:ALEXANDER, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 691-6821
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: 11DATE:
10/27/2021
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Patricia AlexanderTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Personal Rights - Inappropriate interactions occurred between children in home.
INVESTIGATION FINDINGS:
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On 10/27/2021 at 2:05 PM Licensing Program Analyst (LPA) Jeevun Birk-Miller and Licensing Program Manager (LPM) Jeanne Smith conducted an unannounced complaint investigation inspection and met with Licensee, Patricia Alexander. The purpose of the inspection was to inform the Licensee of the finding for the above complaint allegation. It was alleged a day care child (C1) was made to engage in inappropriate behavior by another child (C2) in the facility on multiple occasions. Investigator Sergio Guerra from the Department’s Investigations Branch conducted the investigation in collaboration with the Elk Grove Police Department. The investigator conducted interviews with staff, parents, children, and daycare children. During a forensic interview C1 stated while C1 was using the bathroom at the facility, C2 would enter the bathroom and force C1 to engage in inappropriate activities on multiple occasions. C1’s statements throughout the investigation were detailed and consistent. Licensee stated she does not agree as children are well supervised and does not believe this ever happened. Licensee stated she will be appealing this. Based on the consistent statements made by C1 and the evidence gathered during the investigation the Department found the licensee did not provide adequate supervision which provided... Continue to 9099-C page.

Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 53-CC-20210503133505
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: ALEXANDER, PATRICIA
FACILITY NUMBER: 343619102
VISIT DATE: 10/27/2021
NARRATIVE
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opportunities that allowed C2 to engage with C1 in inappropriate activities. Therefore, the allegation was substantiated. The following Type A deficiency was cited on the 809-D page of this report.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 is available on the website. If the LIC 9224 is not used, the licensee shall prepare a statement indicating the documents have been provided. Licensee shall require the parent/guardian to sign and date the statement and shall keep the signed statement as receipt. Verification of receipt shall be kept in each child's file at the facility. An exit interview was conducted, and Appeal Rights were provided. “
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 53-CC-20210503133505
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: ALEXANDER, PATRICIA
FACILITY NUMBER: 343619102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/27/2021
Section Cited
CCR
102423(a)(4)
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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
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Licensee agrees to monitor more in the nap time areas especailly the kids using the restroom. Licensee stated she will do this without violating privacy. Licensee will also utilize the camera in the home more. Licensee stated the children are no longer at the and have not been back to the facility. Licensee is open to suggestions from Licening regarding
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This requirement was not met as evidenced by: Based on interviews the Licensee did not ensure proper supervision which resulted in Child #1's presonal rights being violated by Child #2. This poses an immediate health and safety risk to children in care.
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supervision in the future. Licensee agrees to submit a written statement to Licensing by 10/28/2021.
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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: Jeanne Smith
LICENSING EVALUATOR NAME: Jeevun Birk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
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