343620691-10-27-2022-53-CC-JSMH-CKN2MR-20221028173135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343620691
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:27:29 PM

Unsubstantiated

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
02/01/2022 and conducted by Evaluator Stacey Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20220201091634

FACILITY NAME:	MARTIN, SHALESE		FACILITY NUMBER:	343620691
ADMINISTRATOR:	MARTIN, SHALESE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 416-5409
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	14	CENSUS: 3	DATE:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Shalese Martin		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained unexplained injuries while in care
Licensee did not make drinking water readily available to child in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On October 27, 2022, Licensing Program Analyst (LPA) Stacey Williams and Licensing Program Manager (LPM) Jeanne Smith met with the Licensee, Shalese Martin to deliver the findings for the above allegation. It was alleged that Child 1 (C1) sustained unexplained facial bruises/injuries while at the facility on 1/31/2022. Investigator Jami Eaton from the Department’s Investigation Branch (IB) conducted the investigation. During the investigation, Investigator Eaton interviewed the Licensee, two staff members, children, parents, medical expert. Investigator Eaton also reviewed records pertinent to the allegation and worked with the Elk Grove Police Department who were involved in the investigation. Staff 1 (S1) and staff 2 (S2) stated C1 played normally in the morning but cried during naptime on 1/31/2022. S1 explained C1 climbed out of the play pen a couple of times during nap time, and S1 had to put C1 back into C1’s play pen. S1 and S2 suggested that C1 could have injured themself on the metal bars in the play pen when trying to climb out. The medical expert who examined C1 could not say with medical certainty how the marks were sustained and could not determine the time frame of when the injuries were obtained.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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 53-CC-20220201091634

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: MARTIN, SHALESE	FACILITY NUMBER: 343620691
	VISIT DATE: 10/27/2022

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

Both staff members acknowledged that when C1 went down for a nap they didn’t notice any marks on C1’s face. However, when C1 woke up both staff members stated they noticed red marks on C1’s face but had no explanation how the marks were sustained. The Licensee was not at the facility during naptime, and therefore, could not explain the injuries. The Licensee also stated that her discipline policy includes re-direction and time out, and that she has a “no hands” discipline policy.

It was also alleged the Licensee did not make drinking water readily available to C1 on 1/31/2022. Licensing Program Analyst (LPA) Stacey Williams conducted the investigation regarding the availability of water. The Report Party (RP) alleged that when RP picked up C1 on 1/31/2022 C1 was extremely thirsty and drank several cups of water. The RP party stated the sippy cup RP provided appeared to be untouched. The Licensee and both her staff members stated there is a water dispenser accessible to children which allows them to access water at any time. The Licensee and her 2 staff members also fill up the children’s sippy cups when they want water. S1 stated C1 was offered water in C1’s sippy cup throughout the day as well as food 1/31/2022. The children at the facility were too young to interview and therefore could not provide any information. LPA interviewed several parents who provided inconsistent information.

Based on the information gathered throughout the investigation there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the finding for the above allegations is unsubstantiated.

An exit Interview was conducted with Licensee. Appeal Rights were provided, and LPA posted a Notice of Site Visit which must remain posted for 30 days.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2