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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500283
Report Date: 05/25/2023
Date Signed: 05/25/2023 02:02:06 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:
05/25/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Shannon LopesTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Personal rights-Licensee is using unsafe equipment with children in care
INVESTIGATION FINDINGS:
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On 05/25/23, Licensing Program Analyst (LPA) Elvira Sierra met with Licensee, Shannon Lopes to deliver the findings for the above complaint allegation. Present in the facility was License and assistant caring for three children.

It was alleged that the facility is using unsafe equipment with children in care. LPA toured the facility and conducted observations. On 03/24/23, LPA observed an exersaucer in the day-care area during the inspection visit. Licensee stated that she was unaware that baby activity center was an exersaucer. Licensee removed the exersaucer during the 3/24/23 inspection visit to an off-limit area. Based on LPA's observations the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. Title 22 Regulation deficiency cited on attached LIC9099-D.

Exit interview conducted. This report and Appeal of Rights were reviewed and provided to Licensee, Shannon Lopes. Notice of Site Visit posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2023
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...Per regulation, excersaucers are categorized as baby walkers and are not allowed in family childcare homes.
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Licensee stated she was unaware that equipment was an exersaucer. License removed the exersaucer during inspection visit to an off limit area.
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 This requirement was not met as evidence by; LPA observed an exersaucer in the daycare area which poses a potential health, safety or personal rights to the 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: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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:10701 SELLERS CIRTELEPHONE:
(510) 282-1208
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 3DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Shannon LopesTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Lack of Supervision-Licensee is not properly supervising children in care.
INVESTIGATION FINDINGS:
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On 05/25/22, Licensing Program Analyst (LPA) Elvira Sierra met with the Licensee, Shannon Lopes to deliver findings for the above allegation. Present in the facility was Licensee and assistant supervising three children.

Throughout the course of the complaint investigation LPA conducted interviews, reviewed documents and made observations. The information gathered throughout the course of this investigation was not enough to support or dismiss the allegation, Licensee is not properly supervising children in care. Based on LPA observations and Interviews with parents that disclosed they don’t have any concerns regarding supervision. Although the allegation 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.

An Exit Interview was conducted in which the report and Appeal of Rights were reviewed and provided to Licensee, Shannon Lopes. Notice of Site Visit posted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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 3