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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700033
Report Date: 09/24/2021
Date Signed: 09/24/2021 01:28:51 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2021 and conducted by Evaluator Brigitte Tsutaoka
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210517125621
FACILITY NAME:SILVA FAMILY CHILD CAREFACILITY NUMBER:
197700033
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
09/24/2021
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Licensee Kumuduni SilvaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation 1: Licensee did not prevent inappropriate interactions between children.
Allegation 2: Licensee did not prevent children from bullying each other.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 24, 2021 at 12:31PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced complaint inspection to deliver findings on the above allegations. The Department of Social Services Community Care Licensing Investigation Branch conducted the investigation on the above allegations. Upon entry, LPA counted 5 children in care with Licensee, Licensee's spouse, and Licensee's adult daughter (on association list).

During the course of investigation, Investigation Branch (IB) Investigator conducted interviews with parents, Licensee, Licensee Spouse, Staff 1, Licensee's adult daughters, and children. Based on evidence obtained and interviews conducted, the allegations are deemed unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations did or did not occur.

An exit interview was conducted, a copy of this report, and a notice of site visit were provided to the Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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