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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 123009388
Report Date: 10/07/2021
Date Signed: 10/07/2021 10:23:39 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2021 and conducted by Evaluator Kiriko Lynch
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20210527153831

FACILITY NAME:SHELLEY, TYISHA FCCHFACILITY NUMBER:
123009388
ADMINISTRATOR:SHELLEY, TYISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 445-8911
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:14CENSUS: 3DATE:
10/07/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tyisha ShelleyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility is dirty and unkempt
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kiriko Lynch conducted an unannounced complaint inspection and met with the Licensee to deliver findings. It was alleged that the facility is unkempt, specifically that there is garbage in the front of the home, excessive dirty dishes, and unclean napping equipment. During the initial video inspection conducted by LPA Jaime Snow on 06/07/21, LPA Snow did not observe any items that appeared dirty or unkempt, however, LPA Snow did observe some clutter from the items used for children of bikes, bags, blankets, etc. as the Licensee conducts childcare in a separate room from the main home residence. On 06/07/21, LPA Snow also observed some dishes in the sink from the morning meal cooked from scratch according to the Licensee, and that is considered acceptable. The children’s bathroom and rug where the children were gathered also appeared clean and uncluttered, and no concerns were noted during the 06/07/21 inspection. On 10/07/21, LPA Lynch observed the area where childcare services are provided in the home to be overall clean and comfortable for children in care. LPA Snow conducted interviews with five parents and two staff. It was reported by some describing clutter at the facility; however, they all denied the allegation apart from one witness interviewed who reported seeing some dog poop in the play yard. The Licensee provided the facility roster and staff information to LPA Snow along with some facility photos taken on 06/07/21. Based on LPA interviews and observations, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. An exit interview was conducted with the Licensee and appeal rights were provided. The Notice of Site Visit must be posted for 30 days.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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