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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 192009402
Report Date: 01/07/2022
Date Signed: 01/07/2022 10:53:00 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2021 and conducted by Evaluator Lisa Clayton
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20211015164211
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
192009402
ADMINISTRATOR:LOPEZ, ANA MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 599-4870
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:14CENSUS: 0DATE:
01/07/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:ANA MARIA LOPEZTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/07/2022, LPA Clayton conducted an un-announced visit to deliver the findings of the above allegations. LPA toured the home for Health & Safety inspection. LPA was greeted by Licensee, who currently has no children in care.
During the investigation, LPA conducted interviews with licensee, the DCFS Social Worker assigned to the complaint, parents/authorized representatives, children, and the individual mentioned in the complaint allegations. Interviews with parents revealed they have no concerns regarding the facility. Parents stated their children have been attending the facility for 2 years or more and that they are happy with the care provided to their children.

Based on LPAs observations, interviews and record review(s), the above allegation(s) is found to be UNSUBSTANTIATED, meaning “Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Exit interview conducted and report was reviewed with the licensee Ana Maria Lopez.
A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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