483009968-8-30-2023-01-CC-LLEI-CV8QM9-20230831121710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483009968
Report Date: 08/30/2023
Date Signed: 08/30/2023 03:03:30 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2023 and conducted by Evaluator Melchisedeck Augustin

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20230530102537

FACILITY NAME:	REID, KANIKA FCCH		FACILITY NUMBER:	483009968
ADMINISTRATOR:	REID, KANIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 805-9647
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	14	CENSUS: 8	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Kanika Reid		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained unexplained injury while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced complaint-investigation visit and met with Licensee (LS), Kanika Reid, for the purpose of delivering finding for the above allegation. LPA, Hernandez Torres previously met with LS on 06/08/23 to initiate the investigation by discussing the purpose of the visit, conducting an interview with LS; and requested a facility roster of the children currently in care. It is alleged that a child sustained unexplained injury while in care. The report noted multiple big red marks on the child's (C1) left buttocks that was warm to the touch.

LPA interviewed LS, one staff (S1), two children (C2 & C3), three adults (A1-A3) and seven parents (P1-P7), starting on 06/06/23 through 08/29/23. Some children were not verbal, too young to interview, or did not qualify to be interviewed. LS denied claims about C1 sustaining injuries at the facility, and stated that C1 was adjusting to the facility, and staff did not hit, harm, or humiliate C1, LS did not see any injuries on C1’s body or had any knowledge of where and how C1 sustained the injury; and LS did not report any other incidents which resulted in injury to children. (Continue to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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 01-CC-20230530102537

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: REID, KANIKA FCCH	FACILITY NUMBER: 483009968
	VISIT DATE: 08/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

According to LS, the indoor/outdoor temperature was not too hot, and LS was the only staff present and did not let the younger children play in the backyard, and LS confirmed the facility’s discipline policy consisted of separating children, placing a child in time out, followed up by staff talking with that child. LS notified parent(s) of incident(s) resulting in injuries to their child via text or phone call(s). S1 stated C1 was not hit or harmed by staff or any other child(ren) in care, and the discipline policy was consistent with the description LS provided.

Statements provided by C2-C3, A2-A3, and P2-P7 did not report any recent or prior injuries to a child(ren), and described they never saw staff/adult hit any child(ren) or saw any child left unattended, and never observed accessible hazards at the facility. P2-P7 conveyed LS never failed to notify them of incident(s) resulting in injury to their child, however; P1 reported on multiple occasions, LS was unaware and did not notify her of several minor scratches P1’s child sustained while at the facility, and P1 had to point out her child’s injuries to LS. C1’s Medical Records Report (MRR) were submitted to the Department on 06/16/23, and MMR did not provide evidence to determine where, when or how C1’s injuries were caused.

Based on the investigation, it could not be determined how and where C1 sustained the injuries, and there were no witnesses or conclusive evidence to confirm C1 sustained the injuries at the facility or sustained the injuries because of inadequate supervision. 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 allegation is unsubstantiated. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. There was no violation(s) of California Code of Regulations, Title 22, Division 12 cited at this time. Appeal Rights were provided.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2