198015828-10-13-2022-54-CC-VCOK-CKMTQK-20221028145606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198015828
Report Date: 10/13/2022
Date Signed: 10/13/2022 02:49:01 PM

Unsubstantiated

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
08/03/2022 and conducted by Evaluator Susann Sanchez

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220803083243

FACILITY NAME:	MOORE FAMILY CHILD CARE		FACILITY NUMBER:	198015828
ADMINISTRATOR:	MOORE, ASHLEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 925-7353
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	14	CENSUS: 6	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Ashley Moore, Licensee		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Licensee speaks inppropriately in the presence of children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced complaint inspection on 10/12/22. LPA arrived at the facility at 1:10 pm. LPA met with Licensee Ashley Moore, for the purpose of delivering the findings for the above allegation. Licensee gave LPA a tour of the facility. LPA observed, 4 children, 2 infants , and 2 staff members present with Licensee during the inspection.

Interviews conducted with parents (5), staff (2) and children (2) did not corroborate the allegation above. All parents interviewed stated that they have never witness Licensee speak inappropriately to children or in front of children. Three of the five parents interviewed stated that they have observed a child misbehaving and they witnessed the Licensee handle the situation by talking to the child and asking the child what she can do to help or by giving a child a separate activity. Children interviewed stated that the Licensee is very nice. However, there was an incident that occurred during operating hours on 08/02/22 with a neighbor. The neighbor was upset children were too loud and there were words that were exchanged in front of children. Words that were exchanged during incident are uncleared. Licensee called the local police. Licensee failed to report incident to the department. Reporting requirements will be cited during today's visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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-20220803083243

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198015828
	VISIT DATE: 10/13/2022

NARRATIVE

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Although the above 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.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Ashley Moore, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 54-CC-20220803083243

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: MOORE FAMILY CHILD CARE	FACILITY NUMBER: 198015828
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/13/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/21/2022 Section Cited CCR 102416.2(a)	1 2 3 4 5 6 7	102416.2(a) Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). The requirement was not met as evidenced by: based on interviews conducted with License.	1 2 3 4 5 6 7	Per Licensee understands that reporting requirements are important and stated to the LPA that she understands that all incidents that affect her facility must be reported to the department within 24 hours. Licensee will email LPA a delcaration from Licensee stating she understands all unusal incident must be
	8 9 10 11 12 13 14	Licensee admitted that she did not report incident at occurred on 08/02/22. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14	reported by POC due date 10/19/22 via email.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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