Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618282
Report Date: 11/21/2019
Date Signed: 11/21/2019 10:00:07 AM


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
11/15/2019 and conducted by Evaluator Mai Lor
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20191115121829
FACILITY NAME:MARIN, MARIA ELENAFACILITY NUMBER:
343618282
ADMINISTRATOR:MARIN, MARIA ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 834-1492
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:14CENSUS: 0DATE:
11/21/2019
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria MarinTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Licensee failed to prevent inappropriate sexual interactions between daycare children
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mai Lor and Licensing Program Manager (LPM) Roxana Saravia met with Licensee Maria Marin for a complaint investigation regarding the above allegation. LPA already investigated the incident after it was self-reported through an unusual incident report (UIR). During the investigation, LPA Lor conducted a health and safety inspection, interviewed children, licensee and her adult daughter acting as her assistant, and a parent. Consistent statements in interviews revealed that a young child engaged in an inappropriate activity that was sexual in nature with another young child. Licensee and her assistant stated they were unaware of the incident until information was provided by the parent. Based on the above, the facility staff did not provide adequate supervision when the day care children use the bathroom. The above allegation is substantiated meaning the preponderance of evidence has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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 03-CC-20191115121829
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: MARIN, MARIA ELENA
FACILITY NUMBER: 343618282
VISIT DATE: 11/21/2019
NARRATIVE
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No deficiencies cited due to the facility being previously cited on 11/13/19 for lack of supervision and deficiency has been cleared. Exit interview conducted and appeal rights provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2