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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197404915
Report Date: 02/02/2023
Date Signed: 02/02/2023 10:58:39 AM

Unsubstantiated


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
11/16/2022 and conducted by Evaluator Loyce Phillips
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20221116151616
FACILITY NAME:WORTHEN FAMILY CHILD CAREFACILITY NUMBER:
197404915
ADMINISTRATOR:LISA WORTHENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 447-8830
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY:14CENSUS: 6DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:LISA WORTHEN, LICENSEETIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Allegation #1: Criminal Record Clearance - Uncleared adult present at the facility.
Allegation #2: Personal Rights - Children exposed to harmful chemicals.
INVESTIGATION FINDINGS:
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On 2/2/2023, Licensing Program Analyst (LPA), Loyce Phillips, conducted an unannounced visit for the purpose of delivering the findings on the above allegations. LPA was greeted by Licensee, Lisa Worthen and toured the facility. LPA observed 6 children in care with 3 staff members. All adults have criminal record clearance.

On 11/22/2022, during initial visit, LPA toured the facility, obtained a copy of the facility roster, documented observations, and interviewed staff.

During this investigation, LPA documented observations, toured the facility, conducted interviews with children, staff and parents. Staff that were interview disclosed the number of employess that work in the facility and all the adults who resides in the home. Staff also disclosed there are no smells of chemicals at the facility. 3 of the 5 parents that were interviewed, disclosed they are aware of all the adults that work and resides at the facility. Parents did not express any concerns or issues regarding the facility. 809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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 30-CC-20221116151616
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WORTHEN FAMILY CHILD CARE
FACILITY NUMBER: 197404915
VISIT DATE: 02/02/2023
NARRATIVE
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Based on the evidence obtained, interviews conducted and observations, the allegations of uncleared adult present at the facility and children are exposed to harmful chemicals are deemed Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur.

No deficiencies are being cited accordance to Title 22 of the California Code of Regulations and/or Health & Safety Codes.

An exit interview was conducted, a copy of this report, appeals rights and a notice of site visit were discussed and provided to Licensee, Lisa Worthen.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2