198015114-5-1-2019-33-CC-KHAD-BC7KZS-20190515082110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198015114
Report Date: 05/01/2019
Date Signed: 05/01/2019 09:51:31 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 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
04/11/2019 and conducted by Evaluator Jennifer Hua

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20190411111028

FACILITY NAME:	WILLIAMS FAMILY CHILD CARE		FACILITY NUMBER:	198015114
ADMINISTRATOR:	WILLIAMS, SHEREAL ELISIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 731-7381
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	14	CENSUS: 2	DATE:	05/01/2019
		UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Shereal Williams		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Lack of supervision resulting in children having inappropriate interactions

INVESTIGATION FINDINGS:

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LPA arrived to facility at 8:41am, no one answered the door. LPA called licensee. LPA waited outside the facility. Licensee returned call and stated she should be back shortly as she was out picking up kids. Licensee returned to facility with 2 kids.

Based on inteviews conducted, information received do not support the allegation.

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.

An exit interview conducted, copy of report given.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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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