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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198013326
Report Date: 12/29/2020
Date Signed: 12/29/2020 01:59:59 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
11/24/2020 and conducted by Evaluator Anomeh Eivazian
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201124121800
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
198013326
ADMINISTRATOR:DAVIS, ELAINE & WENDELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 805-0005
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 4DATE:
12/29/2020
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Elaine Davis, licenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee handled day-care child in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anomeh Eivazian contacted a complaint inspection to the facility via telephone (facetime) for the purpose of delivering the complaint finding due to COVID-19 and pre-cautionary measures. LPA Eivazian identified herself and discussed the purpose of the call.

During this tele-inspection LPA met with licensee, Elaine Davis. The Licensee took this LPA on a tour of the home at 1:15 p.m. During this tour there were 4 children present in the home.

An investigation was conducted regarding the complaint allegation listed above. During the investigation interviews were conducted with Licensee, complainant, children, staff, and one parent. During the course of the investigation LPA obtained a copy of facility roster.

REPORT CONTINUES ON NEXT PAGE 1 OF 3
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020
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 3
Control Number 33-CC-20201124121800
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: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 198013326
VISIT DATE: 12/29/2020
NARRATIVE
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Based on an interview that was conducted with child#1, mother of child #1 wanted child#3 to sleep between child#1 and child#2. On 11/23/2020 early in the morning, child#3 laid down in the middle of child#1 and child#3, licensee came and yelled, why child#3 is in the middle, stand up, and yelled, child#3 started hitting Elaine , because got angry. Per child#1, at that time child#1, child#2, and child#3 were in the room where they were sleeping, in a room where there is a TV and licensee, Elaine was in the living room. Child#3 went to the living room. Child#1 and child#2 were in the living room too. Then licensee, Elaine grabbed child#3 from shoulder and shook child#3 and put child#3 towards the wall where is a TV in living room. Child#3 got mad and started calling words to licensee, Elaine.

Based on an interview that was conducted with child#2, licensee is mean to child#1, child#2 and child#3. There is this one time they got to the daycare early in the morning, child#3 slept in the middle of child#1 and child#2, licensee came and said, child#3 get out of the middle. Per child#2, child#3 has condition and licensee knew about it but did not handle it. Licensee made child#3 mad then child#3 started cursing licensee. Licensee, Elaine took child#3 to the living room, there is a side room and child #1 and child#2 saw licensee put child#3 to the wall, where there is a black bench toward the wall. Per child#2, child#1 and child#2 looked through the door and saw licensee’s hand on child#3 by shoulder area.

Based on an interview that was conducted with child#3, child#3 wanted to lay down in the middle of child#1 and child#2 when feels to hurt. Licensee, Elaine complaint, told child#3 move. Child#3 got angry, did not want to move from middle of child #1 and child#2. Per child#3, mom got mad when Ms. Elanie put her hand on child#3 and put child#3 against the wall. Per child#3, child#3 was in the kitchen when Ms. Elaine put hand on child#3. Per child#3, child#1 and child#2 and licensee were in the kitchen too. Per child#3, Elaine put hand on child#3’s elbow (child#3 pointed to the elbow). Per child#3, child#1 and child#2 were in the room with TV. Per child#3, child#3 called licensee bitch.

Based on an interview that was conducted with licensee, on 11/23/2020 child#1, child#2, and child#3 came to the daycare in the morning around 5:45 a.m, then they went to the sleep in the middle room, with TV where she already put the cots for them to go to sleep.

REPORT CONTINUES TO THE NEXT PAGE 2 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20201124121800
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: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 198013326
VISIT DATE: 12/29/2020
NARRATIVE
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Child#3 fought with child#2 and child #1, they do all the times and settle down, that day they did not settle down. I sat outside the room, I told to child#3 your mother wanted child#1 lay down in the middle of child#3 and child#2, child#3 was fighting. Child#3 was in a very bad mood, came outside, because license went to get some water, called licensee words. Per licensee, child#3 and licensee came to the room where they were sleeping, then child#3 wanted to go inside the house, licensee stated you are not going to my house, and sent a text message to parent #1 at 5:58 a.m. that child#1, child#2, and child#3 are fighting. Per licensee, she did not yell at children or touch child#3. She just blocked child#3 by the hallway door which leads to her home to prevent to enter the house.

Based on interviews that were contacted with two staff and child#4 and child#5 , no disclosures were made.



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 at this time the above allegations are Unsubstantiated.

Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit phone interview was conducted with Elaine Davis, Licensee and a copy of this report was signed by LPA Eivazian. This report along with the LIC 9213, Notice of Site Visit will be sent via email to licensee who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report. The facility representative was provided with the mailing address for the Monterey Park Regional office and agrees to send the original report by mail.


REPORT END 3 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3