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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343621857
Report Date: 05/23/2022
Date Signed: 05/23/2022 10:11:59 AM

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
05/16/2022 and conducted by Evaluator Amanda Blesi
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220516140723
FACILITY NAME:WILKINSON, DEBRAFACILITY NUMBER:
343621857
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/23/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Debra WilkinsonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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PHYSICAL PLANT: Facility has an infestation of cockroaches
INVESTIGATION FINDINGS:
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Licensing Program Analysts, Amanda Blesi and Lea Habtom, arrived to the facility to open the above complaint. Upon arrival, LPA's observed 5 children supervised by licensee and assistant Tiffany. LPA's toured the facility looking for signs of cockroaches. Upon close inspection, LPA's did not see signs of cockroaches, however there were some dead bugs observed in the kitchen drawers and on the floor. Licensee stated she had a cockroach infestation about a month ago, so she's had a pest control come out and spray both front and back yard as well as around the property. Although LPA's did not observe cockroaches in the facility, licensee admitted she has issues with cockroach infestation. The preponderance of evidence standard was met: therefore, the allegation is substantiated.

Deficiency is cited on the following page of this report. See LIC9099-D.
Appeal Rights provided and notice of site visit posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
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 03-CC-20220516140723
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: WILKINSON, DEBRA
FACILITY NUMBER: 343621857
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2022
Section Cited
CCR
102417(b)
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Operation of a Family Child Care Home: The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This requirement was not met as evidenced by:
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Licensee has taken care of the problem by hiring a exterminator to spray her home inside and out every two months and all the food has also been sealed in containers.
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Licensee stated she has had a problem with cockroaches recently. This is a potential health and safety to those in care.
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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: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2