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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619361
Report Date: 04/03/2024
Date Signed: 04/03/2024 01:29:48 PM

Unsubstantiated


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
01/29/2024 and conducted by Evaluator Mandie Goodwin
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20240129152040
FACILITY NAME:HANSEN, NANCYFACILITY NUMBER:
343619361
ADMINISTRATOR:HANSEN, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 682-6640
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:14CENSUS: 5DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Nancy HansenTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Licensee does not keep the crib free of loose articles including blankets
Licensee does not provide adequate supervision to children in care
INVESTIGATION FINDINGS:
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On April 3rd, 2024 Licensing Program Analyst (LPA) Mandie Goodwin met with Licensee Nancy Hansen to deliver findings for a complaint investigation. Upon arrival LPA observed 5 children including 1 infant supervised by Licensee and assistant.

It was alleged that the Licensee does not keep the crib free of loose articles including blankets and that
Licensee does not provide adequate supervision to children in care. During the course of the investigation LPA made observations, collected documentation, and conducted interviews with Licensee, children, and clients.

Upon observations LPA did not observe blankets or other objects in the pack and play. During inspections LPA also observed adequate supervision. Interviews did not state a concern with the supervision of children. One interview stated that they picked up their child during nap time and did not observe any blankets or loose articles in the crib... Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
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-20240129152040
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: HANSEN, NANCY
FACILITY NUMBER: 343619361
VISIT DATE: 04/03/2024
NARRATIVE
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Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No title 22 deficiencies are cited. Exit interview was conducted with Licensee Nancy Hansen and Notice of Site Visit was provided. Notice of site visit to be posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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