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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618560
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:22:06 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
06/06/2024 and conducted by Evaluator Loraine Perez
COMPLAINT CONTROL NUMBER: 03-CC-20240606110527
FACILITY NAME:IBARRA, OBDULIAFACILITY NUMBER:
343618560
ADMINISTRATOR:OBDULIA IBARRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 821-5974
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 8DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Obdulia IbarraTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Provider is operating out of ratio.
INVESTIGATION FINDINGS:
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On Wednesday, June 12, 2024 at 11:40 AM, Licensing Program Analysts (LPAs) Loraine Perez and Tanya Washington met with Licensee Obdulia Ibarra to open and close a complaint investigation regarding an allegation of facility being out of ratio. The purpose of today's inspection was explained to the Licensee. During today's inspection, LPAs toured the facility, conducted an interview with Licensee and reviewed children’s records and facility roster. LPAs observed Licensee and Staff #1 providing care and supervision to eight children; two infants, two preschoolers and four school aged children. Facility is in ratio during today’s inspection.

Reporting Party alleged that the facility was out of ratio on 06/06/2024 and the Licensee was not in the facility. Staff #2 was present on that day with eight children, four infants and four preschool aged children. Licensee admits that her facility was out of ratio the day of 06/06/2024. LPA’s discussed capacity and ratio with and without an assistant with Licensee.
Report continues on LIC9099C

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 3
Control Number 03-CC-20240606110527
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: IBARRA, OBDULIA
FACILITY NUMBER: 343618560
VISIT DATE: 06/12/2024
NARRATIVE
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Based upon evidence obtained and interview with the Licensee there is a preponderance of evidence to support the allegation; therefore, the finding is SUBSTANTIATED.

Title 22 deficiency is cited on the subsequent page of this report (LIC9099D). Licensee acknowledges, that for TYPE A DEFICIENCIES ONLY upon receipt, Licensee shall post LIC9099-D with Type A deficiency 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. LIC9224 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 Licensee. This report was reviewed with the Licensee. Report, appeal rights and LIC9224 were provided and notice of site visit posted.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20240606110527
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: IBARRA, OBDULIA
FACILITY NUMBER: 343618560
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2024
Section Cited
CCR
102416.5(e)
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Staffing Ratio and Capacity-If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
This requirement is not met as evidenced by:
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Licensee stated that she is in the process of hiring two assistants to help her with providing care to children when she is out for personal appointments. LPA will return to clear the deficiency.
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Facility was out of ration on 06/06/2024. Assistant #2 was providing care to four infants and four preschooler alone.
This is an immediate health and safety risk to children 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: Loraine Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3