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Department of
SOCIAL SERVICES

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 525405507
Report Date: 02/15/2017
Date Signed 02/15/2017 12:56:15 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
12/29/2016 and conducted by Evaluator Christen Archer

PUBLIC

COMPLAINT CONTROL NUMBER: 13-CC-20161229124430

FACILITY NAME:	OLIVE VIEW STATE PRESCHOOL		FACILITY NUMBER:	525405507
ADMINISTRATOR:	BROWN, SHELLY		FACILITY TYPE:	850
ADDRESS:	521 ALMOND STREET		TELEPHONE:	(530) 524-5319
CITY:	CORNING	STATE: CA	ZIP CODE:	96021
CAPACITY:	24	CENSUS: 20	DATE:	02/15/2017
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Angie Lorimor		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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A child's medical plan was not followed, resulting in an injury

INVESTIGATION FINDINGS:

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An follow-up complaint investigation visit was made by LPA Chris Archer. LPA Archer met with Site Supervisor Angie Lorimor to discuss the findings of the investigation. It was alleged that a child's medical plan was not followed, resulting in an injury. On 12/15/16, a child in care (child #1 - Confidential Names LIC811) was being assisted in walking by a staff, when the child's legs buckled and the child sustained a broken bone. The administrator provided that child #1 had a known medical condition that made the child susceptible to broken bones and staff had been verbally told to only allow the child to crawl while in care. The administrator stated that no written medical plan for the child was in place when the incident occurred. The incident was reported to the Department on 12/16/16 as an unusual incident, as required. An investigation was conducted including multiple witness interviews and evidentiary document review. Corroborating information was obtained that a written medical plan, physician's recommendation or formal staff training had not yet been completed for child #1's condition prior to the incident and that the child's authorized representative had consented to and instructed staff that the child was ok to be assisted in walking by staff at the facility. Although the allegation may have happened, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is found to be unsubstantiated. See LIC 9099-C for further information.

Inconclusive

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Jordan Monath	TELEPHONE: (530) 895-5948-
LICENSING EVALUATOR NAME: Christen Archer	TELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2017

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2017

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-20161229124430

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: OLIVE VIEW STATE PRESCHOOL	FACILITY NUMBER: 525405507
	VISIT DATE: 02/15/2017

NARRATIVE

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As of 1/1/17, the term “inconclusive” is no longer used to refer to the outcome of certain complaint investigations. Such complaint allegations are now deemed “unsubstantiated.” This document has not yet been updated to reflect this change and for purposes of this complaint investigation the Department’s finding is that this allegation was unsubstantiated. This report was reviewed and discussed with the Site Supervisor. All licensing reports are public information and must be made available upon request for at least three years. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Jordan Monath	TELEPHONE: (530) 895-5948-
LICENSING EVALUATOR NAME: Christen Archer	TELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2017

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2017

LIC9099 (FAS) - (06/04)

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