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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494269
Report Date: 11/08/2021
Date Signed: 11/10/2021 10:09:43 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
06/21/2021 and conducted by Evaluator Lisa Clayton
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210621120455
FACILITY NAME:BOOKER FAMILY CHILD CAREFACILITY NUMBER:
197494269
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:TAMIKA BOOKERTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/08/2021, LPA Clayton conducted an unannounced visit to deliver the findings of the above allegations. LPA toured the home for Health & Safety inspection. Present was licensee, fingerprint cleared employee Sean, and fingerprint cleared son/assistant Anthony and 7 children in care.

LPA observed children being handled appropriately by licensee and staff.

Based on observations, interviews and record review(s) conducted by Investigator Eddie Hector, CDSS/CCLD Investigations Branch, the above allegation(s) is found to be UNSUBSTANTIATED, meaning that 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.
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: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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