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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093616199
Report Date: 07/13/2022
Date Signed: 07/13/2022 01:56:53 PM

Substantiated


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
05/04/2022 and conducted by Evaluator Arianna Manabat
COMPLAINT CONTROL NUMBER: 03-CC-20220504144650
FACILITY NAME:GIFT OF KIDS, THEFACILITY NUMBER:
093616199
ADMINISTRATOR:TOMMASINI, JENNIFERFACILITY TYPE:
830
ADDRESS:5130 GOLDEN FOOTHILLSTELEPHONE:
(916) 941-8751
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:28CENSUS: 24DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jennifer TommasiniTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Outdoor activity space is not free of hazards.
INVESTIGATION FINDINGS:
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On July 6th, 2022 Licensing Program Analyst (LPA) Arianna Manabat and Licensing Program Manager (LPM) Natalie Dunaway, met with Jennifer Tommasini at approximately 11:30pm to close a complaint. Upon arrival, LPA and LPM observed 24 infants in care with 6 staff, director, and the licensee.
It was alleged that the facility’s outdoor activity space is not free of hazards. During the investigation, LPA Arianna Manabat inspected the facility, interviewed the Director, random staff, and parents. Based on interviews, observations, and record review, the above allegation was found to be SUBSTANTIATED. LPA Manabat observed and documented several areas in the infant play yard that is covered with bark but has exposed black mesh netting. LPA observed sections of the mesh that are bunched and wearing, creating bundles of fabric that contain pieces of bark. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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 4
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
05/04/2022 and conducted by Evaluator Arianna Manabat
COMPLAINT CONTROL NUMBER: 03-CC-20220504144650

FACILITY NAME:GIFT OF KIDS, THEFACILITY NUMBER:
093616199
ADMINISTRATOR:TOMMASINI, JENNIFERFACILITY TYPE:
830
ADDRESS:5130 GOLDEN FOOTHILLSTELEPHONE:
(916) 941-8751
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:28CENSUS: 24DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jennifer TommasiniTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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9
Facility did not properly report an incident which threatened the physical or emotional health or safety of an infant.
Infant suffered injury in care due to lack of supervision
Facility is not free of roaches
INVESTIGATION FINDINGS:
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On July 6th, 2022 Licensing Program Analyst (LPA) Arianna Manabat and Licensing Program Manager (LPM) Natalie Dunaway, met with Licensee Jennifer Tommasini at approximately 11:30am to close a complaint. Upon arrival, LPA and LPM observed 24 infants in care with 6 staff, director, and licensee.
It was alleged that the facility did not properly report an incident, which threatened the physical and emotional health and safety, of an infant, facility is not free of roaches, and that an infant suffered an injury in care due to a lack of supervision. Throughout the investigation, LPA Arianna Manabat interviewed the Director, staff members, and parents. It was alleged that the facility does not actively care for the removal of roaches. The Licensee has provided evidence of past pest control visits and is continuing to actively remove the pests. It was found, through interviews, that the infant suffered an injury in care but it was not due to a lack of supervision. The specified injury was communicated to the infant’s authorized representatives the day of occurrence. Through interviews, it was found that the infant’s authorized representatives were aware of the accident and that there was a plan of correction in place. ......Continued on 9099-C............
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20220504144650
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: GIFT OF KIDS, THE
FACILITY NUMBER: 093616199
VISIT DATE: 07/13/2022
NARRATIVE
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Based on the information obtained, LPA Manabat was not able to determine that the infant suffered an injury in care due to a lack of supervision. Due to conflicting evidence, the allegation is determined to be UNSUBSTANTIATED. This means that, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it. An exit interview was conducted. Notice of site visit and appeal rights were also addressed. The Notice of site visit shall remain posted for 30 days for guardian/parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20220504144650
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: GIFT OF KIDS, THE
FACILITY NUMBER: 093616199
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2022
Section Cited
CCR
101238.2(d)(1)
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101238.2 (d) The surface of the outdoor activity space shall be maintained:
(1) In a safe condition for the activities planned.
The surface of the outdoor activity space shall be maintained in a safe condition for the activities planned.
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The Licensee has provide LPA documentation of even mesh and removed bunches of mesh by July 20th, 2022. LPA Manabat has cleared the deficiency as the Licensee provided proof of correction as of 07/13/2022
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This requirement was not met as evidenced by black mesh present in the infant play yard that is bunched in several areas. Licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

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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: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4