<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153808574
Report Date: 07/08/2021
Date Signed: 07/08/2021 03:34:20 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/30/2021 and conducted by Evaluator Caroline Harris
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210430152924
FACILITY NAME:WILLOW CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808574
ADMINISTRATOR:JONES, NIKOLAFACILITY TYPE:
850
ADDRESS:401 WILLOW DRIVETELEPHONE:
(661) 336-5236
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:56CENSUS: 0DATE:
07/08/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Luz AdamsTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not meeting day care child's dietary needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/8/21 Licensing Program Analyst (LPA) Caroline Harris, conducted a telephone call with Program Manager, Luz Adams as the facility was closed for the summer. The LPA explained the above listed allegations to Mrs. Adams. The purpose of today’s call was to close the complaint investigation. The investigation consisted of interviews with the Site Supervisor II, staff, parents, as well as a facility records review.

Although the allegation may have happened or is valid, based on information obtained during the investigation, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited on the attached LIC 9099-D. An exit interview was conducted with Luz Adams. A copy of this report, along with appeal rights, were e-mailed to Mrs. Adams and Mrs. Adams was asked to sign the bottom of the report and e-mail a copy back to the LPA.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 04-CC-20210430152924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: WILLOW CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153808574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
101227(a)(1)
1
2
3
4
5
6
7
Food Services In child care centers providing meals to children, the following shall apply:
All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. This requirement
1
2
3
4
5
6
7
The director agrees to have all staff watch the training video, "Food Service Requirements for Child Care Centers" on the CCL website and submit the sign in sheet to the Fresno CCL office by the due date of 8/13/21.
8
9
10
11
12
13
14
was not met as evidenced by information not being updated in a child's file re: dietary restrictions and the kitchen not having all allergies listed for a child. This is a possible risk to the health, safety or personal rights of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2