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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343619199
Report Date: 02/01/2023
Date Signed: 02/16/2023 01:05:33 PM

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
12/16/2022 and conducted by Evaluator Josiah Gathing
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20221216151414
FACILITY NAME:GUERIN, DEANIEFACILITY NUMBER:
343619199
ADMINISTRATOR:GUERIN, DEANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 395-1916
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:14CENSUS: 6DATE:
02/01/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Deanie GuerinTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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A day care child was injured while unsupervised.
INVESTIGATION FINDINGS:
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On February 16, 2023 at approximately 12:40 PM, Licensing Program Analyst (LPA) Josiah Gathing met with Licensee Deanie Guerin, to amend and close the above complaint investigation. The complaint alleged that a child was injured while left without supervision. LPA interviewed staff, children, and parents. LPA witnessed full supervision of all children in care throughout the investigation. Parent interviews did not provide evidence to support the allegation. LPA learned through Staff interview that a child in the front room was antagonizing another child. To resolve the issue, one child was brought to a different room, leaving the other child alone in the front room momentarily. Upon returning to the front room, the Provider found that the child had sustained an injury while alone. Although the child may have been left alone momentarily, there was not evidence to show that the facility has not met the supervision requirements per regulation.
Based on interviews with staff and parents the preponderance of evidence standard has not been met, and the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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-20221216151414
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: GUERIN, DEANIE
FACILITY NUMBER: 343619199
VISIT DATE: 02/01/2023
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Licensee's signature on this report acknowledges receipt of these rights. This report was reviewed with the Licensee. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.
LPA discussed this report with Licensee and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20221216151414
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: GUERIN, DEANIE
FACILITY NUMBER: 343619199
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
02/02/2023
Section Cited
CCR
102417(a)
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102417(a) The licensee shall be present in the home 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 will discuss supervision requirements with with assistants and adult residents.
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Based on interviews the facility did not comply with the above regulation as there was not direct supervision of a child which poses Health, Safety, or Personal Rights risk to persons 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: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3