334844725-7-1-2022-10-CC-CMAZ-CGCSF3-20220715134938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334844725
Report Date: 07/01/2022
Date Signed: 07/01/2022 09:14:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/24/2022 and conducted by Evaluator Sumayya Habeebulla

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20220224141902

FACILITY NAME:	THOMAS FAMILY CHILD CARE		FACILITY NUMBER:	334844725
ADMINISTRATOR:	THOMAS,APRIL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 766-2799
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	14	CENSUS: 0	DATE:	07/01/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	April Thomas		TIME COMPLETED:	09:20 AM

ALLEGATION(S):

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- Child was injured while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Sumayya Habeebulla made a subsequent unannounced complaint investigation visit to deliver the findings for the above referenced allegation. LPA met with Licensee April Thomas, who was informed of the decision rendered. During this visit, LPA toured facility inside and out and took census. The initial 10-Day investigation visit was conducted by Investigation’s Branch (IB), Vasquez Wilfredo, on 03/01/2022.
Licensing Program Analyst (LPA), Sumayya Habeebulla is delivering the findings of the complaint investigation conducted by Investigations Branch (IB) Investigator, Vasquez Wilfredo. Per interviews conducted, and information gathered, the Investigator Vasquez was unable to corroborate allegation that the child sustained the injury while at the facility. During the course of the investigation, investigator Wilfredo obtained video surveillance of the facility that was shared by Licensee and the footage did not show any incident that could have resulted in the injury of the child at the facility.

SEE LIC 9099C for continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

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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Control Number 10-CC-20220224141902

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: THOMAS FAMILY CHILD CARE	FACILITY NUMBER: 334844725
	VISIT DATE: 07/01/2022

NARRATIVE

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Per interview, there were no witnesses to the injury of the child at the facility. Investigator Wilfredo conducted an interview with a medical professional who was unable to conclude how or when the injury must have occurred. Investigator Wilfredo could not determine how or when the child sustained the broken arm.

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. Appeal rights discussed and provided along with a copy of this report was provided to the Licensee on this date.

A copy of this must be made available to the public upon request for the next 3 years. The Notice of Site Visit (LIC 9213) was posted where the parent/guardian of children enter and exit the facility.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC9099 (FAS) - (06/04)

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