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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103808465
Report Date: 08/16/2022
Date Signed: 08/16/2022 05:08:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2022 and conducted by Evaluator Jeovanna Yanez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220519154926
FACILITY NAME:DERMER'S CREATIVE CAREFACILITY NUMBER:
103808465
ADMINISTRATOR:DERMER, ADAMFACILITY TYPE:
830
ADDRESS:321 W. HERNDONTELEPHONE:
(559) 435-2901
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY:30CENSUS: 19DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Adam DermerTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Infant sustained injury while in care.
Infant's head was covered while sleeping at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/16/2022, Licensing Program Analyst (LPA) Jeovanna Yanez arrived at the facility to conduct an unannounced complaint inspection. The purpose of the inspection was to gather additional information and deliver investigation findings for the above allegations. LPA met with Director, Adam Dermer, and a census was taken. During the course of this investigation, LPA reviewed pertinent records, and interviewed staff and parents of children in care.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency was cited during today's inspection.

An exit interview was conducted with Adam Dermer. A copy of this report and Appeal Rights were provided and discussed. A Notice of Site Visit (LIC 9213) form will be posted on the facility's parent's board and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Juvenal MoctezumaTELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Jeovanna YanezTELEPHONE: (559) 341-5629
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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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