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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 034500273
Report Date: 11/10/2021
Date Signed: 11/10/2021 11:57:01 AM



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
09/30/2021 and conducted by Evaluator Aruna Sridharan
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210930084322
FACILITY NAME:CLARK, JENNAFACILITY NUMBER:
034500273
ADMINISTRATOR:CLARK, JENNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 217-8287
CITY:PIONEERSTATE: CAZIP CODE:
95666
CAPACITY:14CENSUS: 10DATE:
11/10/2021
UNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Jenna ClarkTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Level of Care
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Aruna Sridharan conducted a follow up complaint inspection and met with Licensee Jenna Clark, to deliver the findings for the above complaint allegation. During today's inspection LPA observed 10 children present and assistant. It was alleged that licensee leaves daycare children unsupervised. LPA conducted interviews with Reporting Party, children and licensee.
Based on interviews and information obtained, this allegation is found to be unsubstantiated. An unsubstantiated finding means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore this allegation is unsubstantiated.
An exit interview was conducted. Appeal rights were given and discussed. A Notice of Site Visit was posted during this inspection.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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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