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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 053622109
Report Date: 07/07/2021
Date Signed: 07/07/2021 04:44:07 PM



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
04/30/2021 and conducted by Evaluator Justin L Denton
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210430173252
FACILITY NAME:HENDERSON, JENNIFERFACILITY NUMBER:
053622109
ADMINISTRATOR:HENDERSON, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 649-6497
CITY:VALLEY SPRINGSSTATE: CAZIP CODE:
95252
CAPACITY:14CENSUS: 0DATE:
07/07/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jennifer HendersonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Licensee left child in car seat
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Justin Denton met with Licensee Jennifer Henderson to deliver the finding for the above complaint allegation. This meeting was conducted by phone due to the ongoing COVID-19 pandemic.

The Department received a report alleging that Licensee Henderson left a child in a car seat. Documents were obtained and interviews were conducted with parents on 5/10/21, 5/26/21, and 6/21/21. The licensee was interviewed on 7/7/21. Documents were obtained to verify ages of children in the licensee's care. Information obtained during interviews did not provide sufficient evidence that the licensee left a child in a car seat.

Based on interviews, observations, documentation, and other information gathered, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is unsubstantiated An exit interview was conducted. This report and appeal rights were provided to the licensee by email.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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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