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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405375
Report Date: 09/17/2019
Date Signed: 09/17/2019 05:22:23 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
07/17/2019 and conducted by Evaluator Susan Neeson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190717134616
FACILITY NAME:MCCULLOUGH, KIMFACILITY NUMBER:
073405375
ADMINISTRATOR:MCCULLOUGH, KIMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 374-9893
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:14CENSUS: 9DATE:
09/17/2019
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Sabina Mitchell and Kim McCulloughTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is over capacity
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Susan Neeson met initially with Sabina Mitchell. Visit began at 3:15. Kim Mcculough arrived at 4:15 after being called by her helper. There were two visits for this complaint. LPA did not observe over capacity during either of these visits. However, it was unclear which children and how many were picked up during the day and were taken home rather than coming to the day care. Kim McCullough stated that she does night and weekend care. On Saturday she typically has 10 children and Sunday 4. She stated she has 3 helpers who work varied schedule on Saturday. Interviews were done.

Although the allegation may have happened or is valid, there is not a preponderence of evidence to prove the allegged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019
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
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
07/17/2019 and conducted by Evaluator Susan Neeson
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190717134616

FACILITY NAME:MCCULLOUGH, KIMFACILITY NUMBER:
073405375
ADMINISTRATOR:MCCULLOUGH, KIMFACILITY TYPE:
810
ADDRESS:1920 CARLSON BLVDTELEPHONE:
(510) 374-9893
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:14CENSUS: 9DATE:
09/17/2019
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Sabina MitchellTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not live in the day care home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Susan Neeson met initially with Sabina Mitchell. Visit began at 3:15. Kim Mcculough arrived at 4:15 after being called by her helper. There were two visits for this complaint. LPA observed the home and took photographs on both occasions. There are two rooms, one of which appears to be an office and the other a storage room. Both rooms were open and unlocked. They did not appear to be furnished for regular adult residence, Kim McCullough stated that she does live here and does not reside elsewhere.

Although the allegation may have happened or is valid, there is not a preponderence of evidence to prove the allegged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2