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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313622857
Report Date: 03/14/2022
Date Signed: 03/14/2022 02:50:30 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
01/19/2022 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20220119120206
FACILITY NAME:VAUGHAN, DOLLYFACILITY NUMBER:
313622857
ADMINISTRATOR:VAUGHAN, DOLLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 275-6230
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 6DATE:
03/14/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dolly Vaughan - LicenseeTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
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9
PERSONAL RIGHTS: Adult(s) in home uses inappropriate language while children in care.
PERSONAL RIGHTS: Mask not being worn at home.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
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12
13
 An unannounced inspection was conducted today by Licensing Program Analyst Owens. LPA Owens met with Licensee Dolly Vaughan. Present at time of inspection were licensee, her husband and 6 day care children.

The purpose of the inspection is to close a complaint investigation that was originally opened on January 25, 2022. Based upon the interviews conducted, there was not a preponderance of evidence to support the above allegations or incident occurred therefore, this complainant is unsubstantiated.

An exit interview was conducted. Appeal rights were given and explained to the licensee.

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: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
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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