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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573607570
Report Date: 12/28/2023
Date Signed: 12/28/2023 11:55:04 AM

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
12/21/2023 and conducted by Evaluator Jennie Tedlos
COMPLAINT CONTROL NUMBER: 53-CC-20231221091901
FACILITY NAME:LARA, GUADALUPEFACILITY NUMBER:
573607570
ADMINISTRATOR:LARA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 574-0121
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:14CENSUS: 2DATE:
12/28/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Guadalupe LaraTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Uncleared adult in the home.
INVESTIGATION FINDINGS:
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On December 28, 2023, Licensing Program Analysts (LPAs) Jennie Tedlos and Lauren Scott met with Licensee, Guadalupe Lara for the purpose of opening a complaint investigation. Upon arrival LPAs observed Licensee and another adult (A1) with 4 children.

LPA Tedlos conducted an investigation regarding the complaint allegation listed above. During the investigation, LPA revealed that A1 did not have a criminal record clearance. Licensee states that the adult in the home is her daughter who came to visit and two of the children are her grandchildren for whom she does not provide care for. A1 and the 2 children left the facility after LPAs conducted a brief interview with A1. LPAs toured the entire facility, and conducted an interview with the licensee. LPAs also obtained pertinent information to assist with the investigation.

REPORT CONTINUES ONTO 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
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 3
Control Number 53-CC-20231221091901
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: LARA, GUADALUPE
FACILITY NUMBER: 573607570
VISIT DATE: 12/28/2023
NARRATIVE
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It was alleged that Licensee violated criminal record clearance regulations by allowing an uncleared adult into the home during daycare hours. The Licensee stated that A1 visits the facility up to twice a week, but not during daycare hours.

Based on interviews, file review, and observations conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A Type-A Deficiency is cited on a subsequent 9099-D page.

Licencee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

An exit interview was conducted, and the report was reviewed with the Licensee, Guadalupe Lara. LPA provided Licensee Appeal Rights to the Licensee. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20231221091901
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: LARA, GUADALUPE
FACILITY NUMBER: 573607570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/29/2023
Section Cited
CCR
102370(d)(1)
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102370 Criminal Record Clearance:(d) All individuals subject to a criminal record review...shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department...
This requirement was not met as evidenced
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JR left the facility during the inspection and the licensee states that they do not wish to obtain a clearance or exemption for JR.The Licensee must not allow JR in the home during day care hours and prevent JR from having any contact with clients. Licensee will
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by: Based on observation and interview, the facility did not comply with the section above. The daughter of licensee, Joanna Reynoso, (JR), does not have a Criminal Record Clearance which poses an immediate health, safety, or personal rights risk to children in care.
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write LPA a letter acknowledging that JR must not have any contact with clients or be in the facility during day care hours. LPA will conduct a follow up inspection to clear the POC.
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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: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3