<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073404676
Report Date: 11/03/2021
Date Signed: 11/03/2021 04:57:49 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2021 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20210802100624
FACILITY NAME:LANDON, MINERVAFACILITY NUMBER:
073404676
ADMINISTRATOR:LANDON, MINERVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 522-8241
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 0DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:MINERVA LANDONTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
LICENSE- UNCLEARED ADULT IN HOME
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH LICENSEE MINERVA LANDON TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATION.

UPON ARRIVAL, PRESENT FOR THE VISIT ARE LICENSEE AND HER HUSBAND MICHAEL. PER LICENSEE, TODAY THE DAY CARE IS CLOSED. DURING THIS ANALYST'S LAST VISIT A BRIEF INTERVIEW WAS CONDUCTED WITH LICENSEE AND A COPY OF THE FACILITY'S MOST RECENT ROSTER AND OTHER DOCUMENTS WERE RECEIVED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE THE ABOVE ALLEGATION IS FOUND TO BE SUBSTANTIATED. CALIFORNIA CODE OF REGULATIONS, (Title 22, Division 12 & Chapter number 1), ARE BEING CITED ON THE ATTACHED LIC 9099D.

THE LIC 9211 HAS BEEN GIVEN AND EXPLAINED. A COPY OF THIS FILE SHALL BE POSTED AT THE FACILITY FOR 30 DAYS. THIS REPORT IS ALSO TO BE GIVEN TO ALL DAY CARE PARENTS BY THE NEXT BUSINESS DAY. A COPY IS ALSO TO BE GIVEN TO ANY NEWLY ENROLLED DAY PARENTS FOR UP TO ONE YEAR.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 02-CC-20210802100624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LANDON, MINERVA
FACILITY NUMBER: 073404676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2021
Section Cited
CCR
102370(d)(1)
1
2
3
4
5
6
7
102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department REQUIREMENT HAS NOT BEEN MET: LICENSEE'S SON JOSEPH WHO RESIDES IN THE HOME DOES NOT HAVE A FINGER PRINT CLEARANCE
1
2
3
4
5
6
7
LICENSEE WILL HAVE SON JOSEPH FINGER PRINTED, IN ORDER TO CONTINUE TO RESIDE IN THE HOME. TODAY A CIVIL PENALTY OF $500 WILL BE ASSESSED.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2