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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393623001
Report Date: 02/03/2022
Date Signed: 02/03/2022 01:20:50 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
11/10/2021 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20211110135713
FACILITY NAME:SHWETHA,SHWETHAFACILITY NUMBER:
393623001
ADMINISTRATOR:SHWETHA,SHWETHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 666-0777
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:14CENSUS: 7DATE:
02/03/2022
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Shwetha Shwetha TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Provider hit daycare child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of delivering complaint findings. LPA met with Licensee, Shwetha, Shwetha and observed 7 children being supervised by Licensee and her husband.
An investigation was conducted regarding the allegation listed above. A facility inspection was conducted and interviews were conducted with the reporting party, Licensee, children and parents. Pertinent information was received to assist with investigation. Licensee acknowledged to Licensing that she tapped C1 on their arm. She reported she did this to get their attention to focus. Documents obtain disclosed C1 was tapped on the back of their head to get their attention.

Based on the information received, the allegation is determined to be substantiated. Title 22 deficiencies will be cited on subsequent page, LIC 9099D

Exit interview conducted and appeal rights were provided. Notice of Site Visit was given to the Licensee and shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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-20211110135713
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: SHWETHA,SHWETHA
FACILITY NUMBER: 393623001
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2022
Section Cited
CCR
102423(a)(4)
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(4) 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 eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
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Licensee will review the area of Personal Rights in Title 22 regulations. Licensee will provide Community Care Licensing a statement acknowledging the review and understanding of Personal Rights in Title 22 regulations.
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This requirement was not met as evidenced by: Licensee acknowledged tapping C1 on the back of his head to get their attention. This is a potential risk to the health and safety of children in care.
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This statement will be provided to Community Care Licensing by Plan of Correction date of March 3, 2022.
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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: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2