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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 10/10/2022
Date Signed: 10/10/2022 05:30:12 PM

Unsubstantiated


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
08/15/2022 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220815101850
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 9DATE:
10/10/2022
UNANNOUNCEDTIME BEGAN:
04:50 PM
MET WITH:Ma Natividad GonzalezTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Personal Rights-Staff caused injuries to daycare child
INVESTIGATION FINDINGS:
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On Monday, October 10th, 2022, Licensing Program Analyst (LPA) and Licensing program manager (LPM) Bettina Engelman met with the Licensee, Maria Natividad Gonzales to deliver the finding for the above allegation. Present in the facility were nine children present being supervised by Licensee and Licensee's husband.

The complainant alleged a staff member caused an injury to child #1. During the investigation LPA conducted interviews, observed the care and supervision of children and obtained pertinent documents. Interviews and a review of documents did not reveal evidence that staff (S1) caused injures to Child #1. Staff member (S1) denied the allegation and stated during interviews that Child #1 was running with a toy then fell, receiving an injury to her/his lip. Licensee stated that facility uses time out as a disciplining practice no more than one minute per the age of the child.


Report continues subsequent page 809C--
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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-20220815101850
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: 10/10/2022
NARRATIVE
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Based on the information obtained throughout the course of this investigation, the above allegation could not be substantiated or dismissed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED.

An exit Interview was conducted with Licensee, Ma Natividad Gonzalez. A Notice of Site Visit was posted and must remain posted for 30 days. Appeal of Rights were provided.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2