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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313622857
Report Date: 02/26/2020
Date Signed: 02/26/2020 03:10:56 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2020 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20200109133949
FACILITY NAME:VAUGHAN, DOLLY & RODRIGUEZ, MARIAFACILITY NUMBER:
313622857
ADMINISTRATOR:VAUGHAN, DOLLY & RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 275-6230
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 6DATE:
02/26/2020
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Dolly Vaughan - LicenseeTIME COMPLETED:
03:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
OTHER: Unfingerprinted adult is providing care and supervision.
OTHER: Children are allowed in off limit areas of the home.
OTHER: Child's authorized representative was denied access to the home.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced inspection was conducted today by Licensing Program Analyst Owens and Habtom. LPA's met with licensee Dolly Vaughan. Present at time of inspection is licensees Dolly Vaughan and Maria Rodriguez, Dolly's husband Thomas and 6 day care children. The purpose of the inspection is to close a complaint investigation that was originally opened on January 13, 2020.

Based upon interviews conducted licensee did have family visiting the home on vacation from another country, however there was not a preponderance of evidence to support if un-fingerprinted adults were providing care and supervision. It was also not a preponderance of evidence to support if children were allowed in off limit areas of the home and child's authorized representative was denied access to the home occurred. This complainant is unsubstantiated.

Exit interview was conducted. Appeal rights provided. Notice of site visit posted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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