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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622130
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:09:48 PM

Substantiated


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
04/18/2024 and conducted by Evaluator Dao Vang
COMPLAINT CONTROL NUMBER: 03-CC-20240418091432
FACILITY NAME:MARTINEZ, MARCIAFACILITY NUMBER:
343622130
ADMINISTRATOR:MARTINEZ, MARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 570-2266
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:14CENSUS: 9DATE:
05/16/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marinez, MarciaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee did not provide adequate supervision, resulting in a day care child sustaining an unexplained injury.
INVESTIGATION FINDINGS:
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On 5/16/2024 at 1:00p.m., LPA Pa Dao Vang met with Licensee, Marcia Marinez, for the purpose of an unannounced complaint inspection regarding the above allegation of Licensee did not provide adequate supervision, resulting in a day care child sustaining an unexplained injury. LPA observed the census of 9 children supervised by Licensee and assistant.

On 4/23/2024, LPA made observations and conducted interviews. Licensee knowledge dozing off for 15 minutes during nap time, when LPA entered the facility. All the children were asleep. Licensee explained she was not aware it was not allowed in the facility. LPA learned the assistant was also on lunch break.

During today's inspection, LPA conducted interviews and made observations. All adults obtained criminal clearance prior to working at the facility. Based on an interview, LPA learned Licensee is asleep and do not supervise children when they are napping. Parent interviews shows no concerns.
Continue report on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
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 3
Control Number 03-CC-20240418091432
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: MARTINEZ, MARCIA
FACILITY NUMBER: 343622130
VISIT DATE: 05/16/2024
NARRATIVE
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Based on LPA's observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D. Notice of site visit shall remain posted for 30 days.

Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D 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. The 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. LPA provided a copy of the LIC 9244 to Licensee.

An exist interview was conducted with Licensee Marcia Martinez. A copy of this report, Notice of Site Visit, and Appeal rights are also provided to Licensee. The Notice of Site Visit will remain posted for 30 consecutive days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20240418091432
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: MARTINEZ, MARCIA
FACILITY NUMBER: 343622130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2024
Section Cited
CCR
102417(a)
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102417 Operation of A Family Child Care Home
(a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times...
This requirement was not met as evidenced by...
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Licensee stated it has not happened since 4/23/2024 inspection. Licensee stated it will not happen again and will email LPA a statement about her understandings of the requlation provided.
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Licensee knowledge dozed off for 15 minutes, leaving children unsupervised during napping/resting time. This poses an immediate health, safety, or personal rights risk to persons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3