Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455406533
Report Date: 04/11/2018
Date Signed 04/11/2018 02:40:51 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
03/05/2018 and conducted by Evaluator Patricia Pacheco
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20180305133436
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: 11DATE:
04/11/2018
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Kim LackTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff hit day care child.
Licensee used inappropriate language in the presence of a child.
Child sustained in injury in care which resulted in a mark.
INVESTIGATION FINDINGS:
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A subsequent complaint investigation inspection was conducted at the facility by LPAs Sandra Husband and Patricia Pacheco. It has been alleged that staff hit a child in care. The licensee continued to deny the allegation and stated that neither she nor any of her staff have ever hit any of the children in care. During the investigation inspections, LPA observed staff to be appropriately interacting with children in care. Child, staff and witness interviews were conducted. It was corroborated that none of the staff have been observed to have hit any children in care. Based on available information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated.

It has been alleged that the licensee used inappropriate language in the presence of a child. The licensee continued to deny the allegation and stated that there was a parent who was irate because her child who care was terminated. The licensee stated that when the child was picked up, the parent was upset, but
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2018
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-20180305133436
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
VISIT DATE: 04/11/2018
NARRATIVE
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the licensee stated that she did not use any sort of profanity when engaging with the parent. During the investigation inspections, LPA observed staff to be using appropriate language in the presence of children in care. Child, staff and witness interviews were conducted. It was corroborated that the licensee has not been observed to use inappropriate language in the presence of children in care. Based on available information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated.

It has been alleged that a child sustained an injury in care which resulted in a mark. The licensee continued to deny the allegation and stated that there have not been any recent injuries that she is aware of that left any sort of mark. During the investigation, child, staff and witness interviews were conducted. It was corroborated that there had not been any recent noted children with marks having resulted from an injury obtained while in care at the facility. Based on available information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated.

SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 2