198017313-8-28-2019-54-CC-KCHS-BG4T4P-20190917142415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198017313
Report Date: 08/28/2019
Date Signed: 08/28/2019 12:30:32 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 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
05/13/2019 and conducted by Evaluator Warren Birks

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20190513125957

FACILITY NAME:	PENA FAMILY CHILD CARE		FACILITY NUMBER:	198017313
ADMINISTRATOR:	PENA, DIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 889-4109
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 3	DATE:	08/28/2019
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Diana Pena		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee is under the influence of unknown substance while providing care and supervision.
Daycare children had access to a gun.

INVESTIGATION FINDINGS:

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This is an amended report that was originally issued on 8/16/19.

This complaint inspection was conducted by Licensing Program Analyst (LPA) Warren Birks, for the purpose of delivering the findings for the above pending allegations.

During the course of the investigation interviews were conducted with the Licensee, adult #1, adult #2, and children. During interviews conducted there were no disclosures that anyone had knowledge of a firearm in the home or actually observed a firearm in the home. During the investigation, LPA also conducted an unannouced inspection of the home (including off limit area rooms and observed no firearms.

In addition, there were no disclosures that anyone observed the Licensee use an unknown substance or be under the influence of an unknown substance at the daycare. LPA did not observe the Licensee to be under the influence during four unannounced inspections.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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-20190513125957

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: PENA FAMILY CHILD CARE	FACILITY NUMBER: 198017313
	VISIT DATE: 08/28/2019

NARRATIVE

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The Licensee denied the above allegations and feels the complaint was filed out of retaliation for an unknown reason.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore at this time the above allegation is unsubstantiated The notice of site visit was posted where the parent/guardian of children enter and exit the facility.

Note: LPA received documentation from the Licensee regarding who resides in the home.

This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted with the Licensee, during which appeal rights were explained. A copy of the appeal rights were provided.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC9099 (FAS) - (06/04)

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