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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:08:06 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
01/25/2023 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230125082206
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 4DATE:
04/18/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Brianna RomanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Neglect/ lack of supervision-Provider did not ensure child's mouth was free of choking hazards.
Personal Rights-Provider left day care child soiled for an extended period of time.
INVESTIGATION FINDINGS:
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On 04/18/23 Licensing Program Analyst (LPA) Elvira Sierra met with Licensee's assistant, Briana Roman to deliver findings for the above allegations. Present in the facility was assistant supervising four children.
It was alleged that the provider did not ensure child's mouth was free of choking hazards and provider left day care child soiled for an extended period. During the investigation LPA observed the care and supervision of the children, reviewed records and interview complainant, staff and parents. LPA learned through interviews with staff that diapers are checked many times throughout the day such as before or after napping, before going home or anytime during the day that the diaper needs changing. Licensee's assistant stated that facility request parents to provide diapers and an extra set of clothing in case infant gets dirty and requires changing. LPA received conflicting information during interviews from staff, parents and complainant regarding supervision. Staff disclosed during interviews that staff are always close "keeping an eye" on the children and did not observed anything on Child #1 mouth before child went home.
Report continues on subsequent page 809C--
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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-20230125082206
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: 04/18/2023
NARRATIVE
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Based on conflicting information obtained throughout the course of this investigation the above allegations could not be substantiated or dismissed. Although the allegations may have happened (or are valid), there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the finding are UNSUBSTANTIATED.

An Exit Interview was conducted in which the report and Appeal of Rights were reviewed and discussed with licensee's assistant, Briana Roman. Notice of Site Visit posted.

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

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2