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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 125407570
Report Date: 12/09/2021
Date Signed: 12/09/2021 12:06:14 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
10/28/2021 and conducted by Evaluator Kiriko Lynch
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20211028114123

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:13CENSUS: 7DATE:
12/09/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenshen PerezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
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9
Day care child left in soiled diaper for an extended period of time
INVESTIGATION FINDINGS:
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12
13
On 12/09/21, at 11:00 AM, a closing complaint investigation visit was made to the facility by LPA Lynch. It has been alleged day care child was left in a soiled diaper for an extended period of time. LPA met with the Licensee at the facility during the initial complaint visit on 11/05/21, and conducted an interview. Licensee stated they always check and change diapers as needed throughout the day, but on the day in question staff forgot to mark the diaper chart for the child's second diaper change. Licensee stated she checked by just squeezing the child's diaper in the afternoon that day due to child would become upset if the child's clothes were removed and she would try to accommodate the child. Three former and current parents were interviewed on 12/08/21, and there were generally no disclosures. All current children at the time of the visits were not able to be interviewed due to age. LPA also observed care and supervision during the visits to the facility. Based on interviews and observations, LPA did not find a preponderance of evidence to corroborate the allegation. 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 finding is 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: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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