198014629-10-4-2019-54-CC-KCHS-BGTMTL-20191010095341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198014629
Report Date: 10/04/2019
Date Signed: 10/04/2019 08:42:29 AM

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 CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2019 and conducted by Evaluator Raul Navarro

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20190510115014

FACILITY NAME:	KING FAMILY CHILD CARE		FACILITY NUMBER:	198014629
ADMINISTRATOR:	KING, SHANNON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 437-1451
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	14	CENSUS: 4	DATE:	10/04/2019
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Azalia King		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Personal Rights
Lack of Supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced complaint inspection. LPA met with assistatn Azalia King, Licensee was not available during today's inspection. There was a total of four children present.

During the course of the investigation LPA interviewed the Licensee, staff, and reporting party. Documents from other agencies were obtained and reviewed. Staff interviewed stated they observe an incident between Child #1 and Child #2. Staff interviewed stated it was an isolated incident. Staff also denied that Child #1 sustained an injury while in care. Due to conflicting statements made by all parties involved LPA was unable to determined if the incident occured due to lack of supervision. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated

*Report continues on the next page*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019

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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Control Number 54-CC-20190510115014

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KING FAMILY CHILD CARE	FACILITY NUMBER: 198014629
	VISIT DATE: 10/04/2019

NARRATIVE

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The 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.

Exit interview conducted with the Licensee's Assistant, during which appeal rights were given and explained. A copy of the Appeal Rights (LIC 9058 01/16) was provided. The Licensee’s signature on this report acknowledges receipt of rights.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC9099 (FAS) - (06/04)

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