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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334830940
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:41:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240416130125
FACILITY NAME:THEDFORD FAMILY CHILD CAREFACILITY NUMBER:
334830940
ADMINISTRATOR:THEDFORD, KEICHELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 377-3671
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:14CENSUS: 3DATE:
04/18/2024
UNANNOUNCEDTIME BEGAN:
11:14 AM
MET WITH:Keichel Thedford, LicenseeTIME COMPLETED:
12:52 PM
ALLEGATION(S):
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Child sustained an unexplained injury while in care
Licensee did not ensure first aid practices were applied to child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced complaint visit to the facility. LPA met with Licensee Keichel Thedford (S1) and informed them of the purpose of this visit. During this investigation, LPA conducted interviews with staff, and confidential witnesses, made observations, and obtained supportive documentation for review to assist with determining the finding for the above noted allegations.

It was alleged that a child sustained an unexplained injury while in care, and Licensee did not ensure first aid practives were applied to child. On the day of incident, a child who was not identified in the initial report sustained scrapes and cuts that were not properly treated or covered with a band-aid.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 204-4913
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 10-CC-20240416130125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: THEDFORD FAMILY CHILD CARE
FACILITY NUMBER: 334830940
VISIT DATE: 04/18/2024
NARRATIVE
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Interview with S1 revealed that a child identified as Child One (C1) had a fall outside of the facility on Monday, 4/15/24.

Interview with C1's parent revealed that C1 had fallen in front of them on that date while outside of the facility. C1's parent had a bandage and it was immediately applied to C1's knee. Based on the fact that C1's knee had a bandage applied, S1 found that no further first aid was needed. Additionally, LPA observed C1's knee and found that the wound had healed and developed a scab. Based on observation and interviews, the allegation was found to be Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted where a copy of this report was provided along with a copy of the LIC811 (confidential names list), and Appeal Rights.

A Notice of Site visit was given, and the Licensee understands that it must remain posted for 30 days.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 204-4913
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
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