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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623165
Report Date: 06/23/2023
Date Signed: 06/23/2023 05:05:54 PM

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
03/30/2023 and conducted by Evaluator Karyn Guerra
COMPLAINT CONTROL NUMBER: 03-CC-20230330162423
FACILITY NAME:FLORES, VICTORIAFACILITY NUMBER:
343623165
ADMINISTRATOR:FLORES, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 308-8044
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:14CENSUS: 4DATE:
06/23/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Victoria FloresTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee did not use appropriate form of discipline
INVESTIGATION FINDINGS:
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At 2:45 p.m. on Friday, June 23rd, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Victoria Flores, for the purpose of an unannounced complaint inspection to deliver findings. It was alleged that Licensee did not use appropriate form of discipline. Throughout the course of the investigation, LPA conducted interviews and gathered documentation. It was learned that there was an incident that occurred during a transition to lunch time during which a child was requesting a cookie and was inconsolable and was placed on timeout after they hit a child. The incident was stated to have occured from start to finish for 20 minutes. It was learned that the timeout began for the child once they were calm, and they ate their lunch after the timeout was complete. Licensee stated that there were safety concerns for the other children in care while the incident occurred, and lunch

report continued on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
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 3
Control Number 03-CC-20230330162423
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: FLORES, VICTORIA
FACILITY NUMBER: 343623165
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
07/24/2023
Section Cited
CCR
102423(a)(4)
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Personal Rights. (4) To be free from corporal or unusual punishment,.. humiliation, intimidation,... or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping, or toileting... This requirement was not met, as evidenced by:
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Licensee will provide documentation that personal rights training has been completed by POC due date.
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Based on interview and documentation, the Licensee did not comply with the above regulation.
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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: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20230330162423
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: FLORES, VICTORIA
FACILITY NUMBER: 343623165
VISIT DATE: 06/23/2023
NARRATIVE
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was delayed for the children. Licensee stated that they had attempted to console the child to no avail. The preponderance of evidence standard has been met, and the allegation is substantiated. An exit interview was conducted and a notice of site visit and appeal rights provided. Notice of site visit shall remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3