073408344-6-16-2021-02-CC-MMEA-C44VVQ-20210618164643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073408344
Report Date: 06/16/2021
Date Signed: 06/16/2021 10:40:06 AM

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
05/10/2021 and conducted by Evaluator Paul Peterson

PUBLIC

COMPLAINT CONTROL NUMBER: 02-CC-20210510141911

FACILITY NAME:	GALVEZ, NYISHA		FACILITY NUMBER:	073408344
ADMINISTRATOR:	GALVEZ, NYISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 417-2460
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94803
CAPACITY:	14	CENSUS: 0	DATE:	06/16/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Nyisha Galvez		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Licensee failed to notify child's authorized representative of incidents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced complaint investigation site inspection for this facility at 9:20 AM and met with licensee, Nyisha Galvez. There were no children in care as the facility is currently on break. One prospective parent along with a prospective child were present touring the facility at the time of LPA's arrival.

Based on the investigative findings, although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Licensee was provided a copy of the appeal rights and the signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of the complaint investigation report provided. The Notice of Site visit was provided and posted and is to remain posted for 30 days from this date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021

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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