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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 125407570
Report Date: 02/10/2021
Date Signed: 02/10/2021 04:18:12 PM



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
04/20/2020 and conducted by Evaluator Kiriko Lynch
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20200420150701
FACILITY NAME:PEREZ, JENSHEN FAMILY CHILD CARE HOMEFACILITY NUMBER:
125407570
ADMINISTRATOR:PEREZ, JENSHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 798-7102
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY:14CENSUS: 8DATE:
02/10/2021
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jenshen PerezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
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5
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9
Daycare is unkempt.

Licensee did not ensure that the daycare was free of hazards.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
On 02/10/2021, Licensing Program Analyst (LPA) Kiriko Lynch conducted a closing complaint investigation, and met with the Licensee. The closing complaint investigation was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak. It was alleged the daycare is unkempt and the Licensee did not ensure that the daycare was free of hazards.

The Licensee was interviewed on 04/27/20, and denied the allegations. Licensee stated she maintains a working baby gate at the base of the stairs, does not smoke in the home, and cleans the home on a regular basis. LPA observed and conducted a tour of the home during several tele-visits on 04/27/20, 12/18/20, and 02/10/21, and did not observe a broken baby gate, ash tray, or copious amounts of pet hair. Licensee showed LPA a working baby gate at the base of the stairs at the time of the initial interview on 04/27/20, and the home appeared to be in clean and orderly condition. Three parents/guardians who had children enrolled at the time of the reported allegations were interviewed on 02/08/21, and there were no substantial disclosures corroborating the allegations. Based on interviews, observations of the home, and documentation related to the complaint, LPA did not find a preponderance of evidence to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. An exit interview was conducted, and appeal rights were provided.
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: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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