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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618108
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:06:11 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, 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
08/30/2022 and conducted by Evaluator Fabiola Diaz
COMPLAINT CONTROL NUMBER: 03-CC-20220830155542
FACILITY NAME:PERDOMO, ANAFACILITY NUMBER:
343618108
ADMINISTRATOR:PERDOMO, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 332-9405
CITY:SACRAMENTOSTATE: CAZIP CODE:
95842
CAPACITY:14CENSUS: 2DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Ana PerdomoTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not prevent inappropriate interaction between day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fabiola Diaz arrived at the facility at approximately 9:35 am and met with licensee Ana Perdomo to close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed 2 day care children. During the investigation LPA Diaz made observations, conducted interviews, and gathered documents pertaining to the investigation. It was alleged facility did not prevent inappropriate interaction between day care children. The information attained during the investigation was inconsistent and did not provide the evidence needed to substantiate or dismiss the allegation. 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.
An Exit Interview was conducted in which the report was reviewed and discussed with Licensee. A copy of this report was provided to the Licensee. A Notice of Site Visit and Appeal Rights were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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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