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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 574501020
Report Date: 07/18/2024
Date Signed: 07/18/2024 12:59:37 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
07/16/2024 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240716114223
FACILITY NAME:ROCHA, ABELINA SUEFACILITY NUMBER:
574501020
ADMINISTRATOR:ROCHA, ABELINA SUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 718-9042
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 11DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:licensee, Abelina Sue RochaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Provider operates out of ratio.
Provider did not provide adequate supervision to day care children.
Provider did not notify CCL of incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lauren Scott and Licensing Program Manager (LPM) conducted a complaint investigation. The purpose of the inspection visit was to deliver the finding for the above allegation. LPA toured the facility at time of inspection.

It was alleged the facility was operating out of ratio, provider did not provide adequate supervision to children in care and provider did not notify Licensing of an incident at the facility. LPA conducted observations and interviews while at the facility. During the inspection on July 17, 2024, LPA observed the facility to have 15 children in care. It was also revealed that 2 children got out through the Licensee's side gate and made it out into the Licensee's front yard where they were retrieved by another parent. Licensee stated children were only gone for a couple minutes. Licensee did not report the incident to Licensing and stated she was unaware she needed to but informed the parents/guardians.

REPORT CONTINUES ON LIC 9099C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 4
Control Number 53-CC-20240716114223
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: ROCHA, ABELINA SUE
FACILITY NUMBER: 574501020
VISIT DATE: 07/18/2024
NARRATIVE
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LPA discussed regulations regarding supervision and reporting requirements. Licensee stated she installed a lock on the side gate immediately after the incident occurred. Based on the observations and interviews made, it was determined that the preponderance of evidence standard has been met, therefore the above allegations are 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 licensee 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. licensee 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 the Licensee, Abelina Sue Rocha. 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: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 53-CC-20240716114223
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: ROCHA, ABELINA SUE
FACILITY NUMBER: 574501020
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2024
Section Cited
CCR
102416.5(f)
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(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.

This requirement was not met as evidenced by:
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Licensee sent a child home on 07/17/24, making the overall ratio 14.

On 7/18/24, LPA observed less than 14 children in care.
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Based on observations made on 7/17/24, LPA observed 15 children in care with licensee and one assistant.
This poses an immediate health, safety or personal rights risk to children in care.
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Type A
07/19/2024
Section Cited
CCR
102417(a)
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102147 Operation of a Family Child Care
Home. (a) The licensee shall be present... and shall ensure that children in care are
supervised at all times.
This requirement was not met as evidenced by:
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Licensee has installed alarms on her front door and a lock so that children cannot open on the side gates. LPA verified the locks at time of inspection
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Based on interviews conducted, it was determined that at least one child had wandered from into the front yard of the home, from the backyard side gate and was found by another parent. This is an immediate health and safety risk to children 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: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 53-CC-20240716114223
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: ROCHA, ABELINA SUE
FACILITY NUMBER: 574501020
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2024
Section Cited
CCR
102416.2(b)(2)
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(b) The licensee shall report to the Department any of the events...
(2) Any child absence means any instance where a child in care is missing... child in care who wanders away from the Family Child Care Home. This requirement was not met as evidenced by:
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LPA discussed reporting requirements and LIC624B Unusual Incident Reporting. LPA requested licensee to submit a form for the incident that occurred
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Licensee did not report an incident to licensing where at least one child wandered out of the home and into the front yard of the home and found by another parent.
This is a potential healthy, safety or personal rights risk to children 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: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4