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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500283
Report Date: 03/24/2023
Date Signed: 05/25/2023 01:36:19 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
03/21/2023 and conducted by Evaluator Elvira Sierra
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20230321154554
FACILITY NAME:LOPES, SHANNONFACILITY NUMBER:
394500283
ADMINISTRATOR:LOPES, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 282-1208
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 3DATE:
03/24/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Shannon LopesTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Personal Rights-Licensee does not provide a safe environment for children in care.
INVESTIGATION FINDINGS:
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*This is an amended report.*
On 03/24/23 Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Shannon Lopes to conduct an unannounced complaint inspection for the above complaint allegation. During today’s inspection there were 2 infants and one preschool child being supervised by Licensee.

It was alleged that Licensee does not provide a safe environment for children in care. LPA toured the facility and observed a playpen placed under a television in the living room with exposed electrical cords. Licensee moved the playpen during the visit to an area that does not block the entrance or exit of the home. Also Licensee will make the electrical cords inaccesiible to the children to minimize electrical hazards. Based on LPA observations and record reviews, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.
Report continues on subsequent page 809C--
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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 53-CC-20230321154554
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: LOPES, SHANNON
FACILITY NUMBER: 394500283
VISIT DATE: 03/24/2023
NARRATIVE
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*This is an amended report*
Title 22 Regulation deficiency cited on attached LIC9099-D. Licensee shall post LIC 9099-D 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 licensee.

Exit interview was conducted. This report and Appeal Rights were reviewed and provided to Licensee, Shannon Lopes. LIC 9224 form Acknowledgement of Receipt of Licensing Reports provided


SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20230321154554
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: LOPES, SHANNON
FACILITY NUMBER: 394500283
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/25/2023
Section Cited
CCR
102423(a)2)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights..... These rights include, but are not limited to, the following:2) To receive safe, healthful, and comfortable
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POC; Licensee moved the playpen during the inspection to a safe area in the living room. Licensee stated that she will cover and secure loose electrical cables hanging from the TV by the due date.
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accommodations, furnishings, and equipment. This requirements was not met as evidence by: Per observations and record reviews Licensee failed to provide a safe environment by placing a playupen under a large tv mounted to the wall with exposed cables. This is a violation that poses an immediate risk to the children in care.
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Deficiency Dismissed
Type B
03/24/2023
Section Cited
CCR
102417(g)(10)
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102417 Operation of a Family Child Care Home (g) The home shall be free from defects.....include but not be limited to: (10) A baby walker shall not be allowed on the premises of a family child care home....




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Licensee stated she was unaware that equipmentg was an exersaucer. License removed the exersaucer during inspection visit to a off limit area.
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Per regulation, excersaucers are categorized as baby walkers and are not allowed in family child care homes. This requirement was not met as evidence by;
LPA observed an exersaucer in the ldaycare area. This is a deficiency that if not corrected can pose a risk to the chidlren 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: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3