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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 093624569
Report Date: 10/02/2023
Date Signed: 10/02/2023 12:29:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2023 and conducted by Evaluator Soleil Marx
COMPLAINT CONTROL NUMBER: 03-CC-20230823123830
FACILITY NAME:NICHELMANN, HALEYFACILITY NUMBER:
093624569
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Haley NichelmannTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Day care child sustained unexplained injury while in care
INVESTIGATION FINDINGS:
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On October 2nd, 2023, Licensing Program Analysts (LPAs) Soleil Marx and Kyrsten Williams, met with Licensee, Haley Nichelmann, to close a complaint investigation alleging that a day care child sustained an unexplained injury while in care. During the investigation, LPA inspected the facility, reviewed relevant documentation, observed interactions between licensee/staff and children in care, and conducted staff and parent interviews. Interviews with parents did not reveal concerns of children being injured outside of normal childhood incidents and that they are notified promptly by licensee if injuries occur. Interviews with Licensee/staff revealed parents are notified at pick up for small injuries and called immediately for more serious injuries and that supervision is always maintained to minimize injuries. LPA observed a safe environment and supervision being maintained. LPA did not gather any pertinent information that could prove that a day care child sustained unexplained injury while in care. Although the allegations 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. Exit interview conducted, report reviewed with Licensee, appeal rights provided. Notice of Site was issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
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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