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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153910110
Report Date: 05/24/2021
Date Signed: 05/24/2021 10:45:16 AM



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
03/15/2021 and conducted by Evaluator Luisa Gavoutian
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210315113552
FACILITY NAME:NAVA, MARIANA FAMILY CHILD CAREFACILITY NUMBER:
153910110
ADMINISTRATOR:NAVA, MARIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 229-9271
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY:14CENSUS: 8DATE:
05/24/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Mariana NavaTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Child in care sustained a spiral fracture
INVESTIGATION FINDINGS:
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On 05/24/2021, Licensing Program Analysts (LPAs) Luisa Gavoutian and Roman Iglesias conducted an unannounced complaint visit to provide findings for the above-mentioned allegation. LPAs met with Licensee, Mariana Nava, who accompanied LPAs during tour of facility both inside and outside. A census was taken. This complaint was investigated by Department of Social Services Community Care Licensing Investigations Branch (IB) Investigator, Mariana Lomeli, Badge #111. During the course of the investigation, Investigator Lomeli interviewed staff, parents, children, witnesses, reviewed facility records, police report, and medical documents.

The investigation revealed through interviews, Investigator Lomeli’s observations, and review of records, that although the above allegation may have happened or is valid, there is not a preponderance of evidence at this time to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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-20210315113552
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: NAVA, MARIANA FAMILY CHILD CARE
FACILITY NUMBER: 153910110
VISIT DATE: 05/24/2021
NARRATIVE
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Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is cited during today's visit.

An exit interview conducted with Licensee, Mariana Nava. A copy of this report and Appeal Rights were provided and discussed with Licensee.

A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2