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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 515407891
Report Date: 02/01/2024
Date Signed: 02/01/2024 09:10:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2023 and conducted by Evaluator Sydney Sims
COMPLAINT CONTROL NUMBER: 13-CC-20231025130233
FACILITY NAME:SHIELER, ELLISA FAMILY CHILD CARE HOMEFACILITY NUMBER:
515407891
ADMINISTRATOR:SHIELER, ELLISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 551-3226
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:14CENSUS: 0DATE:
02/01/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Ellisa ShielerTIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Provider did not report unusual incident to child's authorized representative
INVESTIGATION FINDINGS:
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On February 01 , 2024 at 8:47am, Licensing Program Analyst (LPA) S. Sims and B. Mendez conducted an unannounced complaint inspection, and met with licensee Ellisa Shieler. It was alleged that Provider did not report unusual incident to child's authorized representative, specifically that the Licensee failed to report an incident on 10/17/23 where another parent (P1) pushed Child (C1) while in care.
The licensee was interviewed on 11/1/23 at 12:46pm and confirmed the allegations. The Licensee stated that an unusual incident did occur, but the Licensee was not present for the event. The Licensee stated they were not aware that the incident was not reported to the parent.

2 staff were interviewed on 11/1/23 and 12/5/23, S1 confirmed the allegation an stated that the parent was not informed of the incident the day it occurred. S2 could not confirm the allegation and stated that the parent was informed of the incident but S2 was not there to confirm that the parent was informed the day of the incident.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 13-CC-20231025130233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SHIELER, ELLISA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515407891
VISIT DATE: 02/01/2024
NARRATIVE
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During today’s visit facility was toured, and 0 children were in care.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D.

A notice of site was given and must remained posted for 30 days.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 13-CC-20231025130233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: SHIELER, ELLISA FAMILY CHILD CARE HOME
FACILITY NUMBER: 515407891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2024
Section Cited
CCR
102416.2(f)(1)
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As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a).
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Licensee will review the reporting requirement regulations and send statement acknowledging review to LPA Sims via email to [email protected]
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This regulation was not met as evidence by: It was determined that Licensee did not report unusual incident report to parent in no later than the same business day.
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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: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3