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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 293623969
Report Date: 06/19/2023
Date Signed: 06/26/2023 11:11:16 AM

Substantiated


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
03/28/2023 and conducted by Evaluator Matthew Gallo
COMPLAINT CONTROL NUMBER: 03-CC-20230328150431
FACILITY NAME:BECERRA, LAURAFACILITY NUMBER:
293623969
ADMINISTRATOR:LAURA BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 798-3002
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 12DATE:
06/19/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Laura BecerraTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Criminal Record Clearance
INVESTIGATION FINDINGS:
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At 9:10am on 6/26/2023, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Laura Becerra to deliver findings regarding the complaint that was opened on 3/28/2023. Also present today was day care assistant, Samantha Glatt, and twelve day care children.

It was alleged that an uncleared adult was providing care and supervision to day care children. Throughout the investigation, LPA conducted observations, record review, and interviewed Reporting Party, staff, parents, and children. During said interviews, LPA received corroborating information in support of the Reporting Party’s specific allegation, that the licensee’s sister, Julia Sekulich, an uncleared adult, had been working in the facility in the fall of 2022. The preponderance of evidence standard has been met. Therefore, the above allegation is SUBSTANTIATED.

A Type A Title 22 Deficiency has been cited on the attached LIC 9099-D. An immediate civil penalty has been assessed in the amount of $100. Appeal Rights were provided. An exit interview was conducted, and a Notice of Site Visit posted.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
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 2
Control Number 03-CC-20230328150431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BECERRA, LAURA
FACILITY NUMBER: 293623969
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2023
Section Cited
CCR
102370(d)(1)
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d) All individuals subject to a criminal record review...shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee will not have sister present in the facility until a criminal background clearance or exemption is obtained.
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This requirement was not met as evidenced by:
Based on record review and interviews, LPA determined that licensee's sister, who had not obtained a criminal record clearance, had been present and assisting at the facility in the Fall of 2022. This posed an immediate 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: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2