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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573615400
Report Date: 01/29/2024
Date Signed: 01/29/2024 01:09:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 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
12/19/2023 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231219090711
FACILITY NAME:YCOE ALYCE NORMAN HSFACILITY NUMBER:
573615400
ADMINISTRATOR:JACQUELINE TAMFACILITY TYPE:
850
ADDRESS:1200 ANNA STREETTELEPHONE:
(916) 375-7650
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95605
CAPACITY:144CENSUS: 115DATE:
01/29/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Site Director, Jackie TamTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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child sustained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lauren Scott and Licensing Program Manager (LPM) Chayntel Hunter. conducted a complaint investigation visit and met with Site Coordinator, Jackie Tam. LPA toured the facility and observed 115 children.

During the course of the investigation, LPA Scott conducted interviews with the Directors, Teachers, children, and parents. In addition, LPA obtained information pertaining to allegation. It was alleged that “child sustained injuries while in care.” Interviews with parents and children revealed that there were multiple times children sustained various injuries while in care. Interviews revealed that children would have to inform the teachers of the injuries. Although teachers would talk to the children and redirect, injuries continued and no further action had taken place to prevent future occurrences.

----Report continues on subsequent page LIC 9099
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
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-20231219090711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YCOE ALYCE NORMAN HS
FACILITY NUMBER: 573615400
VISIT DATE: 01/29/2024
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.

Upon receipt of Type A citations, the facility shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Director must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.

An exit interview conducted, and report was reviewed with Site Coordinator, Jackie Tam. Appeal of Rights were provided. 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 $100.00.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 53-CC-20231219090711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: YCOE ALYCE NORMAN HS
FACILITY NUMBER: 573615400
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2024
Section Cited
CCR
101223(a)(2)
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To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Staff Meeting will be held to focus on Children’s Personal Rights and supervision. Site director, Jackie Tam will email LPA the sign-in sheet from this meeting. Site director will also create a written plan to address behaviors and future steps to keeping children safe
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Based on interviews conducted, it was revealed that multiple children were sustaining injuries while in care and staff did not take action to prevent future occurrences, which poses an immediate health, safety or personal rights risk to persons in care.
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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: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3