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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 574500499
Report Date: 12/12/2023
Date Signed: 12/12/2023 11:51:58 AM

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
11/03/2023 and conducted by Evaluator Carla Polanco Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20231103112252
FACILITY NAME:GROSS GAITAN, MARITZAFACILITY NUMBER:
574500499
ADMINISTRATOR:GROSS GAITAN, MARITZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 296-2912
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:14CENSUS: 12DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Maritza Gross GaitanTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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License: Facility operating out of capacity.
Ratio: Facility operating outside of ratio.
Personal rights: Facility is not following infant safe sleep regulations.
INVESTIGATION FINDINGS:
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On 12/12/23, Licensing Program Analysts (LPA) Carla Polanco met with Licensee, Maritza Gross Gaitan, to conduct an unannounced visit for the puspose of delivering the findings of a complaint investigation regarding the above allegations. There were 12 children present during the inspection. During the investigation, LPA made observations at the facility, obtained relevant documents, conducted interviews with the Reporting party, Licensee and a qualified assistant pertaining to the allegations.

It was alleged that the facility was operating out of ratio and out of capacity on or around November 1, 2023. During the interview process with Licensee and an assistant, LPA received corroborating statements that the facility was operating out of capacity on October 31, 2023. The licensee’s assistant stated that the facility had fifteen children in care on October 31st due to a Halloween party. In addition, it was also alleged that the facility is not adhering to infant safe sleep regulations. On a visit conducted 11/9/23, LPA observed a pillow inside one of the cribs in the napping area. During LPA’s interview with the Licensee, it was revealed that at least one infant uses a pillow while napping in the crib.

Report continued on LIC9099-C.............
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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-20231103112252
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: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
VISIT DATE: 12/12/2023
NARRATIVE
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The department has found the complaint to be SUBSTANTIATED: meaning that the allegations are valid because the preponderance of the evidence standard has been met. Title 22 Deficiencies have been cited on the subsequent LIC 9099-D page. Upon receipt of Type A citations, the facility shall post and/or provide copies of the LIC 9099-D to parents/guardians of children currently in care and to parents/guardians of newly enrolled children for the next 12 months. Facility must also provide and have parents/guardians sign the LIC 9224, Acknowledging Receipt of Licensing Reports LIC 9099-D. The facility must keep the signed LIC 9224 forms in each of the children’s files.

Exit interview was conducted at which time the report was reviewed with Licensee, Maritza Gross Gaitan. A Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20231103112252
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: GROSS GAITAN, MARITZA
FACILITY NUMBER: 574500499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2023
Section Cited
CCR
102425(b)
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Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidence by:
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Deficiency was corrected on visit date. LPA observed Licensee remove the pillow during visit conducted on 11/9/23. Licensee states that she is no longer putting childdren to nap in the cribs with any lose articles and/or pillows.
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LPA observed a pillow inside one of the cribs. Through interviews with the Licensee, it was revealed that an infant is placed to sleep with the pillow during nap times. This poses an immediate health and safety risk to children in care.
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Type A
12/12/2023
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidence by:
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Licensee states that she will review Licensing videos pertaining to Tittle 22 Capacity Regulations. Licensee states that she is aware of the Large FCCH capacity regulations and ensuring she is within her capacity limits while caring for children.
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It was revealed to LPA through staff interviews that the facility had fifteen children in care on or around 10/31/23. This poses 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: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3