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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500510
Report Date: 11/22/2022
Date Signed: 11/22/2022 11:58:22 AM

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
11/01/2022 and conducted by Evaluator Stacey Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20221101134211
FACILITY NAME:VARGAS-MACHUCA, GRETELFACILITY NUMBER:
394500510
ADMINISTRATOR:VARGAS MACHUCA, GRETELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 507-6126
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 0DATE:
11/22/2022
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Gretel Vargas TIME COMPLETED:
11:38 AM
ALLEGATION(S):
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Reporting Requirements: Provider did not report injuries to child's authorized representative
INVESTIGATION FINDINGS:
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On November 22, 2022, Licensing Program Analyst (LPA) Stacey Williams arrived a the facility for the purpose of delivering complaint findings. LPA met with Licensee, Gretel Vargas- Machuca. LPA observed one child in care.

LPA conducted an investigation that consisted of a facility inspection, review of pertinent documents and interviews with the Licensee, Reporting Party, and parents of children attending the facility. It was alleged that the Licensee did not report injuries to a child's authorized representative. Licensee denied the allegation and reported that she does not recall a child having an injury while at the facility that required an incident report or parent/authorized representative notification. Inconsistent statements were received from the reporting party, Licensee and parents interviewed. The allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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-20221101134211
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: VARGAS-MACHUCA, GRETEL
FACILITY NUMBER: 394500510
VISIT DATE: 11/22/2022
NARRATIVE
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No Title 22 deficiencies have been cited for this complaint.

An Exit Interview was conducted in which the report was reviewed and discussed with Licensee, Gretel Vargas-Machuca. Appeal rights provided. 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: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2