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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 11/18/2021
Date Signed: 11/18/2021 10:45:42 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
09/15/2021 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210915152632
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee, Ma Natividad GonzalezTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee did not prevent inappropriate interactions between children
Licensee used inappropriate discipline methods
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chayntel Hunter met with Licensee, Ma Natividad Gonzalez to deliver the findings of the complaint investigation regarding the above allegations.

During the course of the investigation, LPA Hunter conducted interviews, and obtained information pertaining to allegations. It was alleged that the Licensee did not prevent inappropriate interactions between children and used inappropriate discipline methods. Interviews conducted revealed the Licensee handles children in a rough manner and has used their hands as a form of discipline. In addition, it was revealed that the Licensee allowed an individual in the home to make comments to children using an tone that was intimidating to children in care.

Report continues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 4
Control Number 53-CC-20210915152632
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: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2021
Section Cited
CCR
102423(a)(4)
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102423 Personal Rights (a) Each child... shall have certain rights that shall not be waived... These rights include... (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation... or other actions of a punitive nature. This requirement was not met as evidenced by:
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Licensee is going to utilize time outs as a form of discipline. LPA Hunter discussed Title 22 regulations regarding personal rights and encouraged Licensee to visit the Departments website.
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Based on interviews conducted, it was revealed that the Licensee handles children in a rough manner and has used their hands as a form of discipline. This is an immediate health and safety risk to 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: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20210915152632
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: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2021
Section Cited
CCR
102423(a)(1)
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102423 Personal Rights (a) Each child... shall have certain rights that shall not be waived... These rights include... (1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by:
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Licensee will intervene when children need to be redirected. LPA Hunter discussed Title 22 regulations regarding personal rights and encouraged Licensee to visit the Departments website.
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Based on interviews conducted, it was revealed that the Licensee allowed another individual to make comments to children using a tone that was intimidating to children in care. This is a potential health and safety risk to 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: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 53-CC-20210915152632
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: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
VISIT DATE: 11/18/2021
NARRATIVE
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Based on the interviews conducted it was determined that the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D pages. Upon receipt of Type A citations, the Licensee shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file. Appeal Rights and Notice of Site Visit were provided.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4