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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500342
Report Date: 01/24/2024
Date Signed: 01/24/2024 01:38:52 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
12/29/2023 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231229151656
FACILITY NAME:EVELYN, PATRICIAFACILITY NUMBER:
394500342
ADMINISTRATOR:EVELYN, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 487-2610
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Patricia EvelynTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee is not present in the home the required amount of time while the day care is operating.
INVESTIGATION FINDINGS:
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On January 24th, 2024, at 12:15 PM, Licensing Program Analysts (LPAs) David Nguyen and Lauren Scott conducted a complaint investigation visit and met with Licensee, Patricia Evelyn. The purpose of the inspection visit was to deliver the findings regarding the above allegation. LPA disclosed the purpose of the inspection and was granted entrance. LPA toured the facility inside and outside and observed seven (7) children being supervised by Licensee and two (2) assistants.

During the course of the investigation, LPA Nguyen conducted interviews with Licensee, Assistants, Parents, and Neighbors. In addition, LPA obtained information pertaining to the allegations and observed the care and supervision of the daycare children. It was alleged that “Licensee is not present in the home the required amount of time while the day care is operating.” Interviews conducted with Licensee, Assistant, Parents, and Neighbors revealed that there was time that Licensee, Patricia Evelyn was not present in the home the required amount of time while the day care is operating.
Report continues on LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
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 5
Control Number 53-CC-20231229151656
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: EVELYN, PATRICIA
FACILITY NUMBER: 394500342
VISIT DATE: 01/24/2024
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 allegation is found to be SUBSTANTIATED. The following Title 22 Deficiency is being cited on the subsequent 9099-D page.

Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.


Exit interview conducted and report was reviewed with the licensee. A notice of site visit was provided and must remain posted for 30 days. Licensee's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Nguyen informed licensee, Patricia Evelyn that this report dated January 24th, 2024 documents one (1) Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Nguyen informed the Licensee to provide a copy of this licensing report dated January 24th, 2024, that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
12/29/2023 and conducted by Evaluator David Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231229151656

FACILITY NAME:EVELYN, PATRICIAFACILITY NUMBER:
394500342
ADMINISTRATOR:EVELYN, PATRICIAFACILITY TYPE:
810
ADDRESS:6378 EMBARCADERO DRTELEPHONE:
(209) 487-2610
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:14CENSUS: 7DATE:
01/24/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Patricia EvelynTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee does not reside at the facility.
INVESTIGATION FINDINGS:
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On January 24th, 2024, at 12:15 PM, Licensing Program Analysts (LPAs) David Nguyen and Lauren Scott met with Licensee, Patricia Evelyn to deliver the findings of the complaint investigation regarding the above allegation.

It was alleged that “Licensee does not reside at the facility.” LPA Nguyen conducted observations and interviewed with licensee, licensee’s assistants, parents, and neighbors.

Based on records reviews and the statements from Licensee's, Assistants's, Parents's, and Neighbors’ interviews, and the conflicting information from Reporting Party, LPA Nguyen determined that the complaint was found to be UNSUBSTANTIATED, meaning 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.
Report continues on LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 53-CC-20231229151656
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: EVELYN, PATRICIA
FACILITY NUMBER: 394500342
VISIT DATE: 01/24/2024
NARRATIVE
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Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

An exit interview was conducted with the Licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 53-CC-20231229151656
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: EVELYN, PATRICIA
FACILITY NUMBER: 394500342
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/25/2024
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home…. at all times. Temporary absences shall not exceed 20 percent of the hours ...

This requirement was not met as evidenced by:
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Licensee, Patricia Evelyn, agrees to be present in the home at all times while the day care was operating, to temporarily close down her FCCH facility, and to notify CCLD before she is taking vacations,
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Based on interviews conducted, it was revealed that the licensee was not present in the home for the required amount of time while the day care was operating. This poses a immediate health, safety, or personal rights risk to children in care.
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Licensee agrees to provide a written statement, acknowleging that she understands the regulation. Licensee signs and dates the written statement.
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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: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5