Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 573620071
Report Date: 01/05/2018
Date Signed 04/24/2018 11:34:51 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2017 and conducted by Evaluator Joseph Bweupe
COMPLAINT CONTROL NUMBER: 03-CC-20171108092136
FACILITY NAME:TWINKLE LITTLE STAR CENTERFACILITY NUMBER:
573620071
ADMINISTRATOR:INIGUEZ, JOSEFINAFACILITY TYPE:
830
ADDRESS:1401 EAST GUM AVETELEPHONE:
(530) 204-9709
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY:12CENSUS: 4DATE:
01/05/2018
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Josefina IniguezTIME COMPLETED:
03:52 PM
ALLEGATION(S):
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Facility staff failed to provide adequate supervision resulting in injury.
INVESTIGATION FINDINGS:
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This is an Amended Report for the visit conducted to facility on 01/05/2018. Licensing Program Analyst, (LPA) Joseph Bweupe and Licensing Program Manager (LPM) Sharon Ogbodo met with the Director, Josefina Iniguez to deliver the finding for the above complaint allegation. The complainant alleged that child #1 sustained bruises and scratch marks on their face due to a lack of supervision. During the course of the investigation Complaint Specialist (CS) Jeannie Smith conducted interviews, and reviewed photos and documents related to the incident. The information obtained from staff members as to where and how child #1 sustained the injury was conflicting. Photos of the child’s injury was taken by a staff member at the facility which revealed a bruised left cheek with several marks that may have been scratches. The photo was taken in the PreK-A classroom where preschool children are supervised. The Director stated she and another staff member were present in the infant room when the incident occurred. The Director stated she didn’t actually observe what happened to child #1 but believes they tripped over their own feet, and fell landing face down on the bottom of a cubby shelf where she saw the child when she turned around from the changing table.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Joseph BweupeTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2018
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-20171108092136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: TWINKLE LITTLE STAR CENTER
FACILITY NUMBER: 573620071
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/05/2018
Section Cited
HSC
101429(a)(1)
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This is an Amended Report for the visit conducted to facility on 01/05/2018. Facility was cited for type B instead of type A deficiency.
101429 Responsibility for Providing Care and Supervision for Infants

(a) In addition to Section 101229, the following shall apply:

(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.

On 11/07/2017 child #1 sustained an unexplained injury to their left cheek while in care at the facility.

Licensee Josefina Iniguez stated that she did not agree with Complaint Specialist (CS) Jeannie Smith findings of lack of care and supervision especially when she (CS) states that it is unclear about how the incident occured. The reason is because the incident happened under the director's own care and the director directly explained the process of the incident to CS. Director stated that would sign report but would later appeal report.
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The Director understands that all infants shall be supervised and under direct visual observation and supervision by a staff person at all times, and will ensure she and her staff comply with this regulation. The Director will hold a meeting with staff and explain the regulation for Responsibility of Care and Supervision and have each staff member sign and date an agenda stating they received training on Section 101429 Responsibility for Providing Care and Supervision of Infants and submit agenda to the Department by __________.
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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: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Joseph BweupeTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20171108092136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: TWINKLE LITTLE STAR CENTER
FACILITY NUMBER: 573620071
VISIT DATE: 01/05/2018
NARRATIVE
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The internal incident report provided to child #1’s parent indicates child #1 was injured while in the PreK-A room where the young preschool children are supervised. Based on inconsistent information provided by the staff, it is unclear where and how child #1 sustained the injury. Therefore, the above allegation is substantiated. The following Type A Deficiency is cited on page two of this report. Appeal Rights were provided to the Director, and an exit interview was conducted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Joseph BweupeTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2018
LIC9099 (FAS) - (06/04)
Page: 3 of 3