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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018552
Report Date: 05/24/2019
Date Signed: 06/03/2019 03:38:08 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
05/09/2019 and conducted by Evaluator Susann Sanchez
COMPLAINT CONTROL NUMBER: 54-CC-20190509100405
FACILITY NAME:PERKINS FAMILY CHILD CAREFACILITY NUMBER:
198018552
ADMINISTRATOR:PATRICE MARIE PERKINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 221-5191
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: DATE:
05/24/2019
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Johnny Perkins, Licensee AssistantTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Licensee hit child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Susann Sanchez arrived to the facility above to deliver the findings from the complaint the department received on 05/02/2019. Upon arrival LPA met with licensee assistant Johnny Perkins. Licensee was not present during visit. LPA informed Licensee complaint has been received regarding an alleged violation of personal rights of a child.
Licensee later arrived during visit.
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.
Exit interview conducted with the Licensee. A copy of the appeal rights (LIC9058 01/16) were provided. The Licensee's signature on this report acknowledges receipt of her rights and a copy of this report was provided. Upon receipt, Licensee posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a 100.00 civil penalty.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
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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