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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343617898
Report Date: 03/29/2023
Date Signed: 03/29/2023 11:55:15 AM

Substantiated


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
03/27/2023 and conducted by Evaluator Michelle Pascual
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230327103355
FACILITY NAME:LIMON, ALMA & ALCANTAR, MARIAFACILITY NUMBER:
343617898
ADMINISTRATOR:ALMA L. & MARIA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 285-7930
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 9DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Childrens records
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Michelle Pascual and Carla Polanco arrived at the facility at approximately 10:40 am and met with licensee Alma Limon to open and close out a complaint investigation for the above allegation. Upon arrival, LPA observed 9 children present including the assistant. LPAs conducted an interview with the licensee and made observations.

It was alleged that licensee was not providng the LIC 9224 form to new incoming parents, which acknowledges a previous "A" citations nor explaining why the citations were given.

After interviewing the Reporting Party (RP) and through the self admission of the licensee, who acknowledged that she did not provide the LIC 9224 to new/incoming families and based on the LPA’s investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
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 03-CC-20230327103355
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LIMON, ALMA & ALCANTAR, MARIA
FACILITY NUMBER: 343617898
VISIT DATE: 03/29/2023
NARRATIVE
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Title 22 deficiencies are cited on the subsequent page of this report. An Exit Interview was conducted in which the report was reviewed and discussed with Alma. A copy of this report was provided to Alma. A Notice of Site Visit and Appeal Rights were provided.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20230327103355
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LIMON, ALMA & ALCANTAR, MARIA
FACILITY NUMBER: 343617898
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
102421(a)
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 The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This was not evidenced by:
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Licensee provided a written form, explaining that she understands the purpose of the LIC 9224 and will provide it to all new/incoming families until August 9, 2023. The form was signed by licensee and given to LPA today.
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Licensee admitted to not providing the LIC 9224, acknowledgment forms for previous citation As, that were issues in August 2023. Licensee is required to have all new/incoming families sign the LIC 9224 for 12 months beginning from the initial citation.
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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: Natalie Dunaway
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3