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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500171
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:24:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2024 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240812103319
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 11DATE:
08/14/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ma Natividad GonzalezTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Ratio-Facility is not operating within the license limitation
INVESTIGATION FINDINGS:
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On 08/14/24, Licensing Program Analysts (LPAs) Elvira Sierra and Stacey Williams met with Licensee, Ma Natividad Gonzalez for an unannounced complaint inspection. Present in the facility were Licensee and her two assistants caring for 11 children.

During the investigation, LPA Sierra conducted interviews and reviewed documents. Based on the information received there is evidence that at least two times in the month of May licensee was over her license capacity by having more than14 children in care at one time. The licensee explained that some days she will have 13 children at home with her assistants and that she is riding with 5 more children because she is dropping them off at school. She explained all the children are not at home at the same time. LPA explained to Licensee that her license capacity at one time is 12 to 14 children (depending on the age of the children) regardless of these children are at home or are being transported.

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

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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-20240812103319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
VISIT DATE: 08/14/2024
NARRATIVE
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Based on the information obtained the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1 is being cited on the second page 809D. This report was reviewed, and a copy was left with Licensee, Ma Natividad Gonzalez. Notice of Site Visit posted, and Appeal of Rights provided to Licensee. This report must be provided to parents and parents must sign LIC9224 (Acknowledgement of Receipt of Licensing Reports). Form must remain in all children's files including newly enrolled children for the next 12 months.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20240812103319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GONZALEZ, MA NATIVIDAD
FACILITY NUMBER: 394500171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2024
Section Cited
CCR
102416.5
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102416.5 Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidence by:


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POC; Licensee provided a statement with new children schedules on today's inspection. Licensee stated that she spoke to parents and rearranged the children schedules so she wont be over her License capacity.
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Based on documents received Licensee had more than 14 children under her care at least two times in the month of May.
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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: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3