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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623759
Report Date: 12/19/2022
Date Signed: 12/19/2022 04:04:05 PM

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
12/09/2022 and conducted by Evaluator Arianna Manabat
COMPLAINT CONTROL NUMBER: 03-CC-20221209101859
FACILITY NAME:IBARRA, AMELITAFACILITY NUMBER:
343623759
ADMINISTRATOR:IBARRA, AMELITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 427-2521
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 9DATE:
12/19/2022
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Amelita IbarraTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Absence of Supervision
INVESTIGATION FINDINGS:
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On 12/19/2022, at 2:45 PM, Licensing Program Analyst (LPA) Arianna Manabat and Regional Manager (RM) Jennifer Brekke met with Licensee Amelita Ibarra to close a complaint. During today's visit, LPA and RM observed nine children in care with the Licensee and her Assistant. All individuals subject to a criminal background check have obtained one.

It was alleged that a two year old child wandered from the facility on December 8th, 2022 while the Licensee was asleep. During the investigation, LPA Manabat obtained relevant documentation, inspected the facility, interviewed the Licensee, Reporting Party (RP), and eye witnesses. Based on interviews and record reviews, the above allegation was found to be SUBSTANTIATED. It was confirmed, through record review and interviews, that, on December 8th, 2022, the child wandered from the facility while the Licensee was sleeping in the front living room. According to interviews, the Licensee had fallen asleep sometime between 8:00pm and 9:00pm. Continued on LIC 9099-C...........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
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 3
Control Number 03-CC-20221209101859
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: IBARRA, AMELITA
FACILITY NUMBER: 343623759
VISIT DATE: 12/19/2022
NARRATIVE
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Continued from 9099......
According to interviews, the child had wandered to a neighborhood park and was later found by a family driving past the park at approximately 9:30pm. During the investigation LPA Manabat obtained information that indicated that the child's mother arrived to the facility at approximately 10:00pm. At approximately 10:15pm the child's mother arrived to the park and found her child.

Based on LPA Manabat's investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be Substantiated. Title 22 deficiencies are cited on the subsequent page of this report. LIC 9224 and Appeal Rights were provided. Exit interview conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20221209101859
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: IBARRA, AMELITA
FACILITY NUMBER: 343623759
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2022
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home
(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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The Licensee has implemented alarms and will move her own sleeping arrangements closer to the door.
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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: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3