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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197410498
Report Date: 01/27/2021
Date Signed: 01/27/2021 07:50:08 PM

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
12/16/2020 and conducted by Evaluator Ericka Hill
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20201216111450
FACILITY NAME:COLBY-MARTIN FAMILY CHILD CAREFACILITY NUMBER:
197410498
ADMINISTRATOR:COLBY-MARTIN, KENISHIA S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 753-8308
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:14CENSUS: 9DATE:
01/27/2021
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Licensee - Kenishia Colby-MartinTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Uncleared adult residing in home
INVESTIGATION FINDINGS:
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On 01/27/2021 at 2:30pm Licensing Program Analyst (LPA) Ericka Hill conducted a tele-visit with Licensee, Kenishia Colby-Martin, to deliver the findings for the above allegation. LPA Hill toured the family child care home and observed 9 children being supervised by 2 adults.

During the investigation, LPA Hill conducted two (2) tele-visits, on 12/22/2020 and 01/27/2020, with the Licensee and observed the facility. LPA did not observe any other adults or children residing in the home or assisting with the children.

Interviews with parents and staff revealed that the Licensee and S1 are the main child care providers, apart from two substitutes when needed. LPA observed all four adults fingerprint cleared and associated to the facility.

{continues on LIC9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Ericka Hill
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
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 30-CC-20201216111450
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: COLBY-MARTIN FAMILY CHILD CARE
FACILITY NUMBER: 197410498
VISIT DATE: 01/27/2021
NARRATIVE
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Based on the interviews, observations, and review of records conducted by LPA Hill, the allegation above was found to be Unsubstantiated. An Unsubstantiated finding means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of the LIC9099 and Notice of Site Visit was provided to the Licensee. LPA Hill informed the Licensee to read, sign, and email the LIC9099 back to LPA Hill.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Ericka Hill
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2