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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343622265
Report Date: 11/07/2024
Date Signed: 12/04/2024 01:48:08 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
11/05/2024 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20241105101057
FACILITY NAME:CARBAJAL ATTAOUS, SARAFACILITY NUMBER:
343622265
ADMINISTRATOR:CARBAJAL ATTAOUS, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 390-9791
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 4DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sara Carbajal AttaousTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff hit a child.
INVESTIGATION FINDINGS:
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This report is amended due to an error in the original report. Licensing Program Analyst (LPA) Jennifer Velasco met with licensee Sara Carbajal Attaous (Licensee) for an unannounced initial complaint investigation inspection pertaining to the allegation that Licensee hit a child on the back of the hand. The purpose of today's inspection was explained to Licensee. LPA observed Licensee care for children, reviewed faclity records, and interviewed Licensee and children. Licensee stated that on 11/04/2024, she did lightly tap a child on the back of the hand with her hand, not causing injury. The preponderance of evidence standard has been met; therefore, the above allegations are SUBSTANTIATED. Licensee was informed that this report dated 11/07/2024 and the continuation LIC 9099-D page document one Type A citation and must be posted for parental review for 30 consecutive days. The facility must also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in each child's file for verification. Exit interview was conducted and a copy of this report was given to licensee Sara Carbajal Attaous. Notice of site was given and must remain posted for parental review for 30 days. Appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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-20241105101057
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: CARBAJAL ATTAOUS, SARA
FACILITY NUMBER: 343622265
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2024
Section Cited
CCR
102423(a)(1)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include ... (1) To be treated with dignity in his/her personal relationship with staff and other
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Licensee stated they will develop a detailed written plan for employing behavior management strategies that do not violate children's personal rights. Licensee stated they will email this to LPA on or before close of business on POC due date:
jennifer.velasco@dss.ca.gov.
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persons. This requirement has not been met as evidenced by: Licensee statement that Licensee lightly hit a child on the back of the hand. This is an immediate risk to the health, safety, and personal rights of children 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: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
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