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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 554500150
Report Date: 09/12/2024
Date Signed: 09/12/2024 01:36:03 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
09/09/2024 and conducted by Evaluator Tobias Lake
COMPLAINT CONTROL NUMBER: 53-CC-20240909164710
FACILITY NAME:MACDONALD, CARRIE ELIZABETHFACILITY NUMBER:
554500150
ADMINISTRATOR:MACDONALD, CARRIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 588-3137
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:14CENSUS: 8DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Staff, Tracey Wivell TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Licensees temporary absence exceeds 20% of the day
INVESTIGATION FINDINGS:
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LPA Tobias Lake arrived at the facility to conduct initial investigation. LPA was met by staff and a parent volunteer. There were 8 children present including one infant.
LPA observed the Licensee was not present and was informed by staff and the parent volunteer that Licensee is not present at the facility today because they are on a trip and they won't return until 09/13/2024. Based on LPA’s observations and interviews, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099-D.

An exit interview was conducted in which the report was reviewed and discussed with staff.

Appeal rights were discussed and a printed version was given to staff, Tracey Wivell.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 53-CC-20240909164710
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: MACDONALD, CARRIE ELIZABETH
FACILITY NUMBER: 554500150
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2024
Section Cited
CCR
102352(f)(1)
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102352 (f) (1) "Family Day Care" or "Family Child Care" means regularly provided care, protection and supervision of children, in the care giver's own home, for periods of less than 24 hours per day, while the parents or authorized representatives are away.
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Staff and Parent Volunteer will inform Licensee that they are not allowed to be open until they return to their facility. Licensee will send LPA written acknowledgement stating they understand they must be present for 80 or more percent of open day care hours by 9/16/24
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This requirement was not met as evidenced by: Licensee was not present at their facility during LPA visit; staff and parent volunteer informed LPA that Licensee is away until 9/13/24
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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: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
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