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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846207
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:30:43 PM

Substantiated


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 ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/01/2023 and conducted by Evaluator Karrene Turner
COMPLAINT CONTROL NUMBER: 09-CC-20230201140521
FACILITY NAME:AHLSTRAND FAMILY CHILD CAREFACILITY NUMBER:
334846207
ADMINISTRATOR:AHLSTRAND, DEVIN LEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 651-1295
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:14CENSUS: 4DATE:
02/10/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Devin Le Ahlstrand, LicenseeTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Criminal Record Clearance - Uncleared adult providing care and supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kay Turner arrived at the facility to conduct an investigation regarding a compliant on the above allegation. The complaint states there is an uncleared adult providing care and supervision. LPA met with licensee, Devin Le Ahlstrand, and stated the purpose of today's inspection. The center was toured, and the census was taken.

During the course of the investigation, LPA Turner was conducting a walk through of the home accompanied by the licensee. A male adult exited one of the bedrooms; the licensee confirmed the male adult resides in the home. LPA Turner inquired as to whether the male adult assists in the family child care home. The licensee confirmed the male adult assists in the family child care home, by providing care and supervision to the children, as needed at the request of the licensee. Most recently, the male adult transported a child from school to the facility. A records review indicated the male adult has not received a criminal record clearance. LPA advised the licensee that all adults over the age of 18 living, working, and/or volunteering in a licensed

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
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 4
Control Number 09-CC-20230201140521
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/13/2023
Section Cited
CCR
102370(d)(1)
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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee agrees to have the adult son, David Ahlstrand Jr, submit to fingerprinting and provide the livescan paperwork to the LPA by the POC due date.
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Licensee confirmed the adult son, David Ahlstrand Jr, resides in the home and assists in the care and supervision of day children upon her requests. Licensee confirmed the adult son transported a day child from school to the facility approximately 2-3 weeks prior.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 09-CC-20230201140521
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
VISIT DATE: 02/10/2023
NARRATIVE
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pg 2

facility must obtain a criminal record clearance prior to initial presence in a licensed family child care home.

Based on all the information obtained from pertinent parties, documentation, records review during inspection, the department has determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.



See LIC 9099-D for deficiencies. An immediate Civil Penalty was issued.

Exit interview was conducted with Devin Le Ahlstrand, licensee. A copy of this report, Notice of Site Visit, and Appeal Rights were provided A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4