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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313621167
Report Date: 02/08/2024
Date Signed: 02/08/2024 08:47:34 AM

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
11/15/2023 and conducted by Evaluator Katrina Owens
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20231115170246
FACILITY NAME:BORJA POLANCO, LYANNAFACILITY NUMBER:
313621167
ADMINISTRATOR:BORJA POLANCO, LYANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 663-7018
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 1DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Lyanna Borja - LicenseeTIME COMPLETED:
08:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS: Licensee hits day care children while in care.
PERSONAL RIGHTS: Licensee uses inappropriate forms of punishment with day care children while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced inspection was conducted today by Licensing Program Analyst Owens. LPA met with licensee, Lyanna Borja Polanco. Present at time of inspection was licensee, her assistant and one day care child. The purpose of the inspection is to close a complaint investigation that was originally opened on November 21, 2023.

Based upon the interviews conducted, there was not a preponderance of evidence to support the above allegations or incidents occurred therefore, this complainant is unsubstantiated.

An exit interview was conducted. Appeal rights were given and explained to the licensee at time of inspection. No citations issued.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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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