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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343606960
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:36:57 PM

Substantiated


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
11/19/2024 and conducted by Evaluator Fabian Schwartz
COMPLAINT CONTROL NUMBER: 03-CC-20241119085241
FACILITY NAME:4TH R - TWO RIVERSFACILITY NUMBER:
343606960
ADMINISTRATOR:JEANINNIE SELFFACILITY TYPE:
840
ADDRESS:3201 WEST RIVER DRIVETELEPHONE:
(916) 277-3849
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:150CENSUS: 88DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tamara O'CallaghanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff used foul language towards a child in care. - Substantiated
INVESTIGATION FINDINGS:
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On Thursday 21 November at approximately 2:00pm Licensing Program Analyst (LPA) Fabian Schwartz met with Director Tamara O'Callaghan to open and close a complaint investigation. LPA delivered findings of investigation at end of investigation. At time of inspection there were 88 school aged children being supervised 7 staff and the director.

The department received a complaint alleging that Staff used foul language towards a child in care. During today’s inspection, LPA made observations, gathered documents, and conducted interviews. During today's inspection all interviews conducted confirmed staff had used foul language towards child in care. Based on those observations, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

Report Continued on LIC9099-C........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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
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
11/19/2024 and conducted by Evaluator Fabian Schwartz
COMPLAINT CONTROL NUMBER: 03-CC-20241119085241

FACILITY NAME:4TH R - TWO RIVERSFACILITY NUMBER:
343606960
ADMINISTRATOR:JEANINNIE SELFFACILITY TYPE:
840
ADDRESS:3201 WEST RIVER DRIVETELEPHONE:
(916) 277-3849
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:150CENSUS: 88DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tamara O'CallaghanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff attempted to kick a child in care. - Unsubstantiated
INVESTIGATION FINDINGS:
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On Thursday 21 November at approximately 2:00pm Licensing Program Analyst (LPA) Fabian Schwartz met with Director Tamara O'Callaghan to open and close a complaint investigation. LPA delivered findings of investigation at end of investigation. At time of inspection there were 88 school aged children being supervised 7 staff and the director.

During today’s inspection, LPA made observations, gathered documents, and conducted interviews. During complaint investigation, there was insufficient evidence to support allegations of Staff attempted to kick a child in care.

Although the allegations may have happened, there is not a preponderance of evidence to prove the allegations; therefore, the allegations are unsubstantiated. Exit interview was conducted and report was reviewed with Director, Tamara O'Callaghan. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 03-CC-20241119085241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: 4TH R - TWO RIVERS
FACILITY NUMBER: 343606960
VISIT DATE: 11/21/2024
NARRATIVE
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Report Continued from LIC9099.....


1 Type A Title 22 deficiency is being cited for Staff using foul language towards a child in care. That citation is being explained in more detail on accompanying LIC9099-D Page.

Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Facility. LIC 9224 and Appeal Rights were provided. Licensee's signature on this report acknowledges receipt of these rights.

This report was reviewed with the Director and an exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 03-CC-20241119085241
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: 4TH R - TWO RIVERS
FACILITY NUMBER: 343606960
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2024
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
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Director has had staff conduct exrtra trainings for appropriate behavior and language use while working with children. Staff #1 will have performance reviews to monitor future improvement with communication skills with children in care.
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Based on observation and interview, the facility did not comply with the section cited above by having an incident where Staff #1 used foul language towards Child #1 which poses an immediate 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: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4