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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 293623969
Report Date: 01/17/2023
Date Signed: 01/17/2023 10:04:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 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
09/16/2022 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 03-CC-20220916121851
FACILITY NAME:BECERRA, LAURAFACILITY NUMBER:
293623969
ADMINISTRATOR:LAURA BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 798-3002
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 6DATE:
01/17/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:TIME COMPLETED:
10:20 AM
ALLEGATION(S):
1
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9
Day care child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
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13
Licensing Program Analysts Matthew Gallo and Jennifer Velasco (LPA) conducted a follow up complaint investigation inspection and met with Licensee Laura Becerra (L1). The complaint alleged that a child suffered a personal rights violation while in care. The Investigative Branch (IB) investigated the complaint through a series of interviews with medical staff, the licensee, and other witnesses. IB found that although a child did incur injuries, there was not sufficient enough evidence to conclude the incident(s) occurred while the child was in care. Based on the information gathered throughout the course of this investigation there was not sufficient enough evidence nor information to support or dismiss the above allegation. Therefore, the finding for the above allegation was determined to be UNSUBSTANTIATED. An exit interview was conducted in which the report was reviewed and discussed with the licensee, who was also provided with appeal rights and a notice of site visit to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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