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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011388
Report Date: 03/09/2020
Date Signed: 03/09/2020 01:11:58 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2020 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 33-CC-20200304154232
FACILITY NAME:PATRICK FAMILY CHILD CAREFACILITY NUMBER:
198011388
ADMINISTRATOR:PATRICK, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 441-4418
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 5DATE:
03/09/2020
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle PatrickTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Day care child injured while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Justin Dorsey and Bardo Baluyot conducted an unannounced complaint inspection to the above facility for the purpose of conducting an complaint invstigation. Analysts met with Licensee Michelle Patrick, who gave LPA a tour of the facility.

Census: Licensee and Staff #1 with 5 children. During today's investigation interviews and observations, observation were conducted, and criminal record clearances were reviewed.

During the course of the investigation, LPA Dorsey and Baluyot interviewed complainant, Licensee, staff and children of the program. According to the complainant Child #1 sustained a injury at the facility due to lack of supervision. Per interview with Licensee and Staff #1, Child #1 was crawling in the home and tried to push himself up when his arm slipped from under him causing him to bump his head. According to both the Licensee and Staff #1 first aid was rendered as soon as the injury occured. Though there were statements indicating Child #1 was injured at the facility, LPA's could not indicate it was due to lack of supervision.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 33-CC-20200304154232
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198011388
VISIT DATE: 03/09/2020
NARRATIVE
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Based on interviews and observations the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted with, and a copy of this report has been signed by and provided to Licensee Michelle Patrick, Notice of Site Visit and Appeal Rights were given.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3382
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2