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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493598
Report Date: 04/06/2020
Date Signed: 04/06/2020 04:38:15 PM



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
12/23/2019 and conducted by Evaluator Shandra Powell
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20191223115236
FACILITY NAME:GRAY FAMILY CHILD CAREFACILITY NUMBER:
197493598
ADMINISTRATOR:AMBER & QUINCY GRAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 200-4473
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 11DATE:
04/06/2020
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:AMBER & QUINCY GRAY, LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical Abuse
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Shandra Powell, Licensing Program Analyst (LPA), conducted a telephone interview/inspection to the facility for the purpose of delivering the findings on the above allegation. LPA spoke with licensee Amber Gray, Licensee per licensee she had 11 children in care during telephone interview all children are related to Essential Workers.

Based upon the evidence obtained through the course of investigation conducted by Edward Hector, Investigator, interviews were conducted with staff, parent of child in question, children, as well as a review of police reports and other pertinent documents and reports. This also included observations at the facility, and interviews with relevant parties. There is insufficient evidence to support or disprove that staff injured child while in care. Therefore, this allegation has been determined unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred at this time.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation. Failure to maintain posting as required will result in a civil penalty of $100.00. An exit interview was conducted and a copy of this report and appeal rights will be provided via email and US mail to licensee for original signature.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2020
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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