034500295-9-22-2023-53-CC-CHUR-CVWVHN-20230922162724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 034500295
Report Date: 09/21/2023
Date Signed: 09/22/2023 11:29:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
08/28/2023 and conducted by Evaluator Katy Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20230828092317

FACILITY NAME:	BLUM, CHRISTINA AND JOSHUA		FACILITY NUMBER:	034500295
ADMINISTRATOR:	BLUM, CHRISTINA AND JOSHUA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 588-3455
CITY:	JACKSON	STATE: CA	ZIP CODE:	95642
CAPACITY:	14	CENSUS: 5	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Joshua & Christina Blum		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Care provider hit day care child with an object causing bruising.

INVESTIGATION FINDINGS:

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On 09/21/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted an unannounced field visit to deliver the findings for the above allegation. LPA arrived at the Family Child Care Home (FCCH) and was met by Licensee Joshua Blum (L1) and Licensee Christina Blum (L2) arrived shortly after LPA's arrival. LPA disclosed the purpose of the inspection and was granted entrance into the FCCH. LPA toured the facility and observed 5 preschool aged children being supervised by L1. Also present in the FCCH was L1's adult brother. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

Throughout the course of the investigation, LPA conducted physical plant inspections, on-site observations, and interviews. LPA reviewed the facility’s file and collected documentation pertaining to the allegation. It was alleged that a care provider hit a day care child with an object causing bruising. Interviews revealed conflicting information and statements.
CONTINUED ON 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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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Control Number 53-CC-20230828092317

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BLUM, CHRISTINA AND JOSHUA	FACILITY NUMBER: 034500295
	VISIT DATE: 09/21/2023

NARRATIVE

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LPA could not determine that the care provider hit a child with an object. LPA could not determine that the bruise was caused by the care provider.

Based on interviews, observations, documentation, and other information gathered, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is UNSUBSTANTIATED. In the areas that were evaluated on 09/21/2023, no deficiencies were cited. An exit interview was conducted with L1 and L2 and Appeal Rights were provided by LPA. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

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