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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624142
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:01:31 AM

Substantiated


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
09/09/2022 and conducted by Evaluator Alize Tillery
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220909161942
FACILITY NAME:MCCLARA, XIAOPINGFACILITY NUMBER:
343624142
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/13/2022
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Joy McClara TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Licensee is swaddling infants in care
INVESTIGATION FINDINGS:
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On 10/13/2022, at approximately 8:40 AM, Licensing Program Analysts (LPAs) Alize Tillery and Josiah Gathing made an unannounced visit to conclude the complaint investigation for the allegation listed above. Upon arrival, LPAs observed 2 children, supervised by Licensee and Licensee's assistant.

The complaint allegation is that Licensee is swaddling infants in care. Upon arrival, Licensee showed LPAs the room where infants sleep. LPAs observed a sleep sack hanging from the crib. LPAs asked who uses this sleep sack, Licensee responded Child #1. LPAs asked Licensee how many infants she has enrolled. Licensee responded 3. LPA asked how many of the infants use sleep sacks, Licensee responded all 3 bring sleep sacks from home. During LPAs investigation, LPAs were also provided pictures that showed an infant napping in two different sleep sacks/swaddles, while in Licensee’s care. Based on observations and interview, the allegation “Licensee is swaddling infants in care” is Substantiated and a Type A deficiency is being cited for violating Safe Sleep Regulations. LPAs provided Licensee with the Safe Sleep Regulations and FAQs.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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-20220909161942
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: MCCLARA, XIAOPING
FACILITY NUMBER: 343624142
VISIT DATE: 10/13/2022
NARRATIVE
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A deficiency is cited on the following 9099D page.

Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC 9099-D with Type A deficiency 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. LIC9224 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.

LIC9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit posted.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20220909161942
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: MCCLARA, XIAOPING
FACILITY NUMBER: 343624142
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/14/2022
Section Cited
CCR
102425(f)
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(f) An infant shall not be swaddled while in care.
This requirement was not met, evidenced by:
LPAs were provided pictures of a child that was napping in a sleep sack/convertible swaddle while in Licensee's care.
On 10/13/2022, LPAs observed a sleep sack in the napping room. Licensee stated that
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Licensee will submit to LPA Tillery, correspondence stating that she will not use sleep sacks/suits. Licensee is going to submit a waiver request to her analyst.
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all 3 infants that are currently enrolled are using sleep sacks.
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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: Alize Tillery
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3