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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197492761
Report Date: 06/21/2019
Date Signed: 06/21/2019 11:37:30 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2019 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20190501112545
FACILITY NAME:SHELLEY FAMILY CHILD CAREFACILITY NUMBER:
197492761
ADMINISTRATOR:SHELLEY, NICOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 878-1429
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 7DATE:
06/21/2019
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nicole ShelleyTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Supervision-Licensee not providing adequate supervision to day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lady King conducted a subsequent complaint inspection for the purpose of delivering the findings for the above allegation. LPA met with licensee Nicole Shelley to discuss the complaint investigation. The investigation consisted of interviews with relevant parties, including staff, parents and review of supportive documentation. Information gathered reveal no report of child being injured while in the care of licensee. Licensee had 3 large dogs kept in rear yard behind a chain link fence. Since LPA initial visit licensee decided to relocate the dog kennel to the rear side yard of the home. Based on the information obtained from interviews the above complaint is being unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Neglect/Lack of Supervision is deemed unsubstantiated.

Exit interview conducted and a copy of the report was left with the licensee on this day.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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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