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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500395
Report Date: 12/11/2024
Date Signed: 12/11/2024 01:36:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. 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
10/18/2024 and conducted by Evaluator Erwin Tjhia
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20241018113742
FACILITY NAME:PINA, NIZARINDANDIFACILITY NUMBER:
394500395
ADMINISTRATOR:PINA, NIZARINDANDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 833-5761
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:14CENSUS: 6DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nizarindandi PinaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee did not adequately supervise day care children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee, Nizarindandi Pina to deliver findings of the complaint investigation regarding the above allegations. There were 6 children during the visit.

Throughout the investigation, LPA conducted observations and interviewed with Licensee. It was alleged that Licensee did not adequately supervise day care children in care resulting in Child #1 sustaining several bite marks by another child while in care. Interviews with licensee revealed that Child #1 was left in the living room with other children for about 30 second when the biting incident happened. The interview reveal that the licensee left the living room to put another infant to sleep at the other room.

Based on interviews conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 2
Control Number 53-CC-20241018113742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PINA, NIZARINDANDI
FACILITY NUMBER: 394500395
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2024
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
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Licensee stated they will implement redirection strategies and develop a plan with parents when children are in their biting stage. Licensee will provide a written plan of action and submit it to LPA.
Licensee disenrolled the child that caused injury to another child by bitting. The child last day was on 11/01/2024.
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Based on interviews and record reviews, the licensee did not adequately supervise day care childre as bite marks were sustained while in care which poses an potential health, safety, or personal rights 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: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2