<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 344500398
Report Date: 12/02/2022
Date Signed: 12/02/2022 01:06:58 PM

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
10/14/2022 and conducted by Evaluator Nola Maestas
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20221014091725
FACILITY NAME:GOLDEN, STEPHANIEFACILITY NUMBER:
344500398
ADMINISTRATOR:GOLDEN, STEPHANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 200-7570
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:14CENSUS: 8DATE:
12/02/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Stephanie GoldenTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused bruising to day-care child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/02/2022, Licensing Program Analyst Katy Maestas (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA disclosed the purpose of the inspection and was granted entrance into the family childcare home (FCCH). LPA observed 6 preschool-aged children and 2 infants under the care of 2 adults. LPA determined, through accessing Guardian, that all required adults are background cleared. Licensee Stephanie Golden (L1) arrived at approximately noon after picking up school-aged children. LPA was able to meet with L1.
Throughout the course of the investigation, LPA conducted observations, interviews, reviewed and collected documents, and conducted a file review. It was alleged that a staff member (S1) caused bruising to a child (C1) in care. Multiple interviews revealed that C1 did not have any bruising or marks on arms on the evening of 10/12/2022 nor were there any visible marks or bruising on the morning of 10/13/2022. Interviews and photographs reveal that red marks and bruising were present on C1’s left arm after being picked-up from daycare on 10/13/2022.
CONTINUED ON LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
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 3
Control Number 53-CC-20221014091725
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: GOLDEN, STEPHANIE
FACILITY NUMBER: 344500398
VISIT DATE: 12/02/2022
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
Interviews with children and staff corroborate that there was an incident on 10/13/2022 between S1 and C1 when S1 attempted to get C1 to lay down during nap time. C1 disclosed that S1 grabbed C1, resulting in bruises on C1's arm.
Based on interviews, file reviews, and observations conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. As a result, a Type-A citation was issued on a subsequent 809-D page. L1 understands that all parents or authorized representatives currently enrolled, and who enroll for up to 1 year, are required to sign the LIC 9224. The LIC 9224 form is to be kept in each child's file and available for the Department's review. An exit interview was conducted in which the report and Plan of Correction was reviewed with L1. LPA provided L1 with Appeal Rights. A Notice of Site Visit was posted by LPA and shall remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20221014091725
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: GOLDEN, STEPHANIE
FACILITY NUMBER: 344500398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/02/2023
Section Cited
CCR
101223(a)(3)
1
2
3
4
5
6
7
(a) The licensee shall ensure that...: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping
1
2
3
4
5
6
7
L1 will ensure that S1 participates in training that addresses the social and emotional development of children. L1 will email LPA the certificate of completion of said training by no later than 01/02/2023. L1 will email a signed statement to LPA which confirms that S1 will not work alone but will only work
8
9
10
11
12
13
14
 or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by: LPA learned from interviews that a staff member (S1) grabbed a child’s arm, causing bruises.
8
9
10
11
12
13
14
under the supervision of another day-care emplyee or L1 for the period of 1 year. The signed statment will be emailed to LPA by no later than 01/02/2023.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3