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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619207
Report Date: 12/08/2023
Date Signed: 12/08/2023 11:55:54 AM

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
09/14/2023 and conducted by Evaluator Jennie Tedlos
COMPLAINT CONTROL NUMBER: 53-CC-20230914135418
FACILITY NAME:BAKER, HALLYFACILITY NUMBER:
343619207
ADMINISTRATOR:HALLY BAKERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 681-5008
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 6DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Hally BakerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee conducted COVID test on day care child without parental consent.
INVESTIGATION FINDINGS:
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On December 8, 2023, Licensing Program Analysts (LPAs) Jennie Tedlos and Corina Beckby met with Licensee, Hally Baker for the purpose of delivering complaint findings. LPAs observed 6 children supervised by the Licensee and an Assistant. Criminal record clearances were verified.

LPA Tedlos conducted an investigation regarding the complaint allegation listed above. LPAs toured the facility, conducted interviews with the Reporting Party (RP), Licensee, Assistant and parents of children that attend and have attended the facility. LPAs also obtained pertinent information to assist with the investigation.
It was alleged that Licensee violated the personal rights of a child (C1) by administering a COVID-19 test without parental consent. The Licensee stated that she administered a COVID-19 test to C1 as per her facility policy.

REPORT CONTINUES ONTO 9099-C... *Licensee decided not to sign the report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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
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
09/14/2023 and conducted by Evaluator Jennie Tedlos
COMPLAINT CONTROL NUMBER: 53-CC-20230914135418

FACILITY NAME:BAKER, HALLYFACILITY NUMBER:
343619207
ADMINISTRATOR:HALLY BAKERFACILITY TYPE:
810
ADDRESS:8654 WINTERFEST COURTTELEPHONE:
(916) 681-5008
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 6DATE:
12/08/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Hally BakerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Child was isolated outside unsupervised.
Licensee did not keep day care children's personal information confidential.
Licensee did not post licensing information at the facility.

INVESTIGATION FINDINGS:
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On December 8, 2023, Licensing Program Analysts (LPAs) Jennie Tedlos and Corina Beckby met with Licensee, Hally Baker for the purpose of delivering complaint findings. LPAs observed 6 children supervised by the Licensee and an Assistant. Criminal record clearances were verified.

LPA Tedlos conducted an investigation regarding the complaint allegations listed above. LPAs toured the facility, conducted interviews with the Reporting Party (RP), Licensee, Assistant, and parents of children that attend and have attended the facility. LPAs also obtained pertinent information to assist with the investigation.
It was alleged that the Licensee violated the personal rights of a child (C1) by not providing adequate supervision by isolating C1 in the backyard unattended. The Licensee stated that the child was isolated to the backyard immediately upon arrival at the facility as a precaution in case the child was contagious and was supervised by herself and an assistant.
REPORT CONTINUES ON 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 53-CC-20230914135418
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: BAKER, HALLY
FACILITY NUMBER: 343619207
VISIT DATE: 12/08/2023
NARRATIVE
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It was alleged that the Licensee violated the personal rights of children in care by not keeping children's medical information confidential. Licensee states that names of children who are sick are not named specifically when informing parents of outbreaks. Parent interviews did not confirm the allegation.

It was alleged that the Licensee violated licensing requirements by not posting licensing information at the facility. Parent interviews did not confirm the allegation.

Based on lack of clear corroborating evidence, the above allegations 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 violations did or did not occur; therefore, the findings are UNSUBSTANTIATED.

An exit interview was conducted in which the report was reviewed and discussed with the Licensee, Hally Baker. LPA provided a copy of the report and Appeal Rights to Licensee. A Notice of Site Visit was posted by LPA and Licensee understands it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Licensee decided not to sign the report. Dot in the signature line is the licensee's signature.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20230914135418
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: BAKER, HALLY
FACILITY NUMBER: 343619207
VISIT DATE: 12/08/2023
NARRATIVE
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Based on interviews, file review, and observations conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A Type-A Deficiency is cited on a subsequent 9099-D page.

Licencee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days 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. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

An exit interview was conducted, and the report was reviewed with the Licensee, Hally Baker. LPA provided Licensee Appeal Rights to the Licensee. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Licensee decided not to sign the report.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20230914135418
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: BAKER, HALLY
FACILITY NUMBER: 343619207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2023
Section Cited
CCR
102423(a)(1)
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102423 Personal Rights (a)Each child... shall have certain rights that shall not be waived...by the licensee regardless of consent...from the child's authorized representative. These rights include, but are not limited to, the following: (1) To be treated with dignity in his/her personal relationship
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Licensee will revise the COVID-19 policy in the handbook to reflect that only parents may administer COVID-19 tests on the front porch. Licensee will require parents to sign a form stating that they administered a COVID-19 test at the facility...Licensee will read The California Department of Public
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with staff and other persons. Based on record review and interviews, the licensee did not comply with the section because Licensee administered a COVID-19 test to a child without parental consent. This poses an immediate health, safety or personal rights risk to persons in care.
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 Health's (CDPH) information on COVID-19 testing for child care providers. Licensee will email LPA stating she has read the CDPH information, and send LPA an updated policy and parent form regarding COVID-19 testing requirements.
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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: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5