343618621-1-13-2022-03-CC-RSAA-CAVVGP-20220121152554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343618621
Report Date: 01/13/2022
Date Signed: 01/13/2022 10:25:40 AM

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
10/29/2021 and conducted by Evaluator Fabiola Diaz

COMPLAINT CONTROL NUMBER: 03-CC-20211029120506

FACILITY NAME:	STILES, KIMBERLY		FACILITY NUMBER:	343618621
ADMINISTRATOR:	STILES, KIMBERLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 344-2446
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY:	14	CENSUS: 3	DATE:	01/13/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kimberly Stiles		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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9

Child sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Fabiola Diaz arrived at the facility at approximately 9:45 am and met with licensee Kimberly Stiles to close a complaint investigation, regarding the above allegation. Upon arrival, LPA observed 3 day care children. During the investigation LPA Diaz made observations, conducted interviews, and gathered documents pertaining to the investigation. It was alleged that Child 1 sustained an unexplained injury while in care. Child 1 did not receive medical treatment for the injury. Licensee explained that Child 1's parent was notified of the incident before Child 1 was picked up that day. Staff interviews disclosed that Child 1's minor injury was an accident with Child 1's own toy. Parent interviews disclosed no concerns with the facility, discipline policy, nor incidents at the facility. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022

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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