197494870-2-10-2022-30-CC-CESO-CBJ3YS-20220210174021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494870
Report Date: 02/03/2022
Date Signed: 02/10/2022 03:22:09 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
11/19/2021 and conducted by Evaluator Lisa Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20211119151342

FACILITY NAME:	AYALA FAMILY CHILD CARE		FACILITY NUMBER:	197494870
ADMINISTRATOR:	JACQUELINE AYALA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 897-7008
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	14	CENSUS: 12	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee Jacqueline Ayala		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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PERSONAL RIGHTS
– Adult had inappropriate contact with a child in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lisa Rios made an unannounced inspection to the Ayala Family Child Care (FCC) Home on 2/3/22 at 9:00am for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with Licensee and together discussed the investigation details.

Based on the interviews conducted and statements obtained by LPA Rios and the Department’s Investigations Branch, Investigator Sonia Sandoval, the allegation cannot be substantiated. 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 is UNSUBSTANTIATED.

Exit interview was conducted with the Licensee. Appeal Rights were issued, and a copy of this report was left at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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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