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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623873
Report Date: 11/09/2023
Date Signed: 11/09/2023 10:35:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2023 and conducted by Evaluator Lea Habtom
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20230911133044
FACILITY NAME:JIMENEZ, MELINAFACILITY NUMBER:
343623873
ADMINISTRATOR:JIMENEZ, MELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 247-2530
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY:14CENSUS: 4DATE:
11/09/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melina JimenezTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Staff left day-care child in a soiled diaper for a long period of time
Staff did not properly clean a child in care
Staff did not provide an adequate amount of water to children in care
Adult in home used an inappropriate form of discipline
Licensee left day-care children unsupervised
INVESTIGATION FINDINGS:
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On November 9, 2023 Licensing Program Analysts (LPAs) Lea Habtom and Tanya Washington made an unannounced inspection to the facility. The purpose of today’s inspection is to close a complaint investigation. LPA met with licensee Melina Jimenez to deliver the findings. The census for today is 1 infant and 3 preschool children being supervised by licensee. All staff present today have been fingerprint cleared and associated to the facility. There were no other adults in the home during the inspection.

During the investigation, LPA Habtom conducted interviews and observation regarding the allegations of personal rights consisting of child being left in soiled diaper, child not receiving assistance when using the bathroom, children not being offered an adequate amount of water, inappropriate form of discipline and children left alone with no supervision. From staff, reporting parting, parent and licensee interviews, LPA Habtom was unable to gather enough further information to validate the allegation that the licensee violated a child’s personal rights therefore the allegations is to be unsubstainted. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
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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