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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153910248
Report Date: 09/27/2019
Date Signed: 09/27/2019 10:29:13 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
07/02/2019 and conducted by Evaluator Daniel Q Alvarez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190702162040
FACILITY NAME:FORD, SHANITA FAMILY CHILD CAREFACILITY NUMBER:
153910248
ADMINISTRATOR:FORD, SHANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 670-4031
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:14CENSUS: 4DATE:
09/27/2019
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Shanita Ford TIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulted in children inappropriately touching each other
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Daniel Alvarez at facility today to close a complaint investigation regarding the above allegation. LPA Alvarez met with licensee Shanita Ford, and explained the purpose of today's inspection and census taken. Based upon LPA Alvarez interview with Ms. Ford conducted on 7/10/2019, along with complaint report detail of allegation/detail of incident that corresponded with each other. The allegation for lack of supervision resulted in children inappropriately touching each other is found to be SUBSTANTIATED.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: (see LIC9099-D).

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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-20190702162040
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: FORD, SHANITA FAMILY CHILD CARE
FACILITY NUMBER: 153910248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2019
Section Cited
CCR
102417(A)
1
2
3
4
5
6
7
Operation of a Family Child Care Home. The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
1
2
3
4
5
6
7
Per licensee, she will not allow children to build forts that prevent direct vision supervision of children.
8
9
10
11
12
13
14
This requirement was not met as evidenced by interview conducted and records reviewed.
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: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Daniel Q AlvarezTELEPHONE: (559) 341-8684
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2