Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455406533
Report Date: 01/24/2017
Date Signed 01/24/2017 02:23:20 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/22/2016 and conducted by Evaluator Patricia Pacheco
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20161122144115
FACILITY NAME:LACK, KIMBERLY FAMILY CHILD CARE HOMEFACILITY NUMBER:
455406533
ADMINISTRATOR:LACK, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 510-1928
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:14CENSUS: 12DATE:
01/24/2017
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Kimberly LackTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Inappropriate discipline.
INVESTIGATION FINDINGS:
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A subsequent complaint investigation visit was made to the facility by LPAs Jim Petelin and Patricia Pacheco. It has been alleged that the licensee has used inappropriate disciplinary measures with the children in care; specifically, placing a child on timeout in an enclosed dark room. LPA met with the licensee and discussed the allegation. The licensee acknowledged that she has used the small room off of the kitchen for naps and timeouts. Licensee also admitted to closing the door to the room if the child is yelling and/or screaming. During the initial facility visit, LPA observed the room had a crib, pack and play, and shelves for storage. Based on interviews conducted during the investigation and other available information, though it could not be determined that the lights were turned off while children were placed in the room for time out, the preponderance of evidence standard has been met. Isolating children alone in a room with the door closed is inappropriate discipline, and therefore, the allegation is substantiated. An exit interview was conducted during which this report was reviewed with the licensee, a plan of correction was discussed and appeal rights were provided. The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 9099D.
Notice of Site Visit shall be posted for 30 days from today's visit.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2017
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 13-CC-20161122144115

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: LACK, KIMBERLY FAMILY CHILD CARE HOME
FACILITY NUMBER: 455406533
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2017
Section Cited
102423(a)(4)
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Personal Rights. Each child shall be free from corporal or unusual punishment.
During the investigation, it was corroborated that the license has used inappropriate discipline with children by isolating children alone in the napping/time-out room with the door closed.
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Licensee agrees to submit a written plan of correction which outlines appropriate forms of discipline that will be used with children in care. Licensee agrees to not close the door of the napping/time out room when children are placed on timeout.
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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.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2017
LIC9099 (FAS) - (06/04)
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