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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393610932
Report Date: 06/10/2022
Date Signed: 06/10/2022 11:35:54 AM

Unsubstantiated


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
06/06/2022 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220606091922
FACILITY NAME:CAPC-CENTRAL 1FACILITY NUMBER:
393610932
ADMINISTRATOR:KIM PAWLOWICZFACILITY TYPE:
850
ADDRESS:540 N. CALIFORNIA ST.TELEPHONE:
(209) 644-5323
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:24CENSUS: 13DATE:
06/10/2022
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Moma SyhachackTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Reporting Requirements-Facility not communicating with authorized representative(s).
INVESTIGATION FINDINGS:
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On Friday, June 10th, 2022, at 09:05am, Licensing Program Analyst (LPA) Elvira Sierra conducted an unannounced complaint inspection to investigate the above allegation and met with Center Manager, Moma Syhachack who guided LPA on a tour of the facility. Upon arrival, present in the facility were 13 preschool age children being supervised by three staff members who have all been fingerprint cleared through Community Care Licensing.

It was alleged that the facility is not communicating with authorized representative(s). During the investigation LPA conducted interviews with various staff members and families in care. Center Manager stated that all parents were contacted on Friday, June 3rd, 2022, at the end of the day via telephone call and emails were sent to inform acility was closing Monday, June 6th, 2022, due to renovation of the preschool classroom and also because short staffing. Center manager stated that facility just thired an additional staff member do the facility does not closed due to staffing.
Report continues on subsuquent page 809C--
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
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 53-CC-20220606091922
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: CAPC-CENTRAL 1
FACILITY NUMBER: 393610932
VISIT DATE: 06/10/2022
NARRATIVE
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 Based on the information obtained the above allegation could not be substantiated or dismissed. 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 finding is UNSUBSTANTIATED.

A Notice of Site Visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Notice of Site Visit was posted by LPA. Exit interview conducted and this report and Appeals of rights were discussed and reviewed with the Center Manager, Moma Syhachack.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC9099 (FAS) - (06/04)
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