198016464-8-17-2022-54-CC-VCOK-CHL2LE-20220823172925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016464
Report Date: 08/17/2022
Date Signed: 08/17/2022 01:10:49 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
06/16/2022 and conducted by Evaluator Dayna Chambers

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220616082514

FACILITY NAME:	VAN LEEUWEN FAMILY CHILD CARE		FACILITY NUMBER:	198016464
ADMINISTRATOR:	VAN LEEUWEN, TRINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 522-5192
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	14	CENSUS: 4	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Trina Van Leeuwen, Licensee		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Child sustained injury while in care

INVESTIGATION FINDINGS:

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On August 17, 2022 at 11:30AM, Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced inspection at the facility noted above and met with Licensee, Trina Van Leeuwen. The purpose of the inspection was to deliver the complaint investigation findings for the allegations noted above. There were 4 children observed during inspection. During the course of investigating the allegation, LPA Chambers conducted confidential interviews and record reviews. The interviews revealed that the licensee and staff provide adequate care and supervision. The interviews also revealed that the licensee provided proper notification by text message regarding an incident involving Child #1. LPA took a photograph of the kitchen and equipment on 06/22/22. LPA obtained a photo of Child #1 after the incident and a medical summary report dated 06/22/22 at 3:45pm. The medical summary stated on page #7 of 14 pages, per physician, the injury did not appear serious at the time and provided care instructions. Interviews indicated Licensee was close to Child #1 at time of incident and the assistant was also present at the time. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did nor did not occur, therefore, the allegation is unsubstantiated. Appeal rights were provided and discussed with licensee. No deficiencies were cited. An exit interview was conducted, and a copy of the report was provided to Trina Van Leeuwen, Licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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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