343622318-4-22-2020-03-CC-RSAA-BP3N8D-20200427101410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 343622318
Report Date: 04/21/2020
Date Signed: 04/22/2020 10:25:04 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
07/19/2019 and conducted by Evaluator Christopher Bello

PUBLIC

COMPLAINT CONTROL NUMBER: 03-CC-20190719115319

FACILITY NAME:	VANG, MAI		FACILITY NUMBER:	343622318
ADMINISTRATOR:	VANG, MAI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 385-2000
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	14	CENSUS: 2	DATE:	04/21/2020
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Mai Vang		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Conduct inimical: an adult in the home having inappropriate interactions with a child not in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Christopher Bello conducted a Tele-inspection via FaceTime with the licensee of the facility to close a complaint investigation. LPA met with licensee Mai Vang, also present was licensee’s fiancée. LPA observed two children at time of tele-inspection. There was a conduct inimical allegation regarding an adult in the home having inappropriate interactions with a child that was not in care. During the investigation LPA made observations and gathered documents pertaining to the investigation. Licensee stated she does not believe that it occurred and that it was a ridiculous accusation. Further investigation was conducted by Investigator Shannan Borton. Interviews conducted did not corroborate the allegation. Based on Investigator Borton’s investigation, the preponderance of evidence standard has not been met and 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
There were no Title 22 deficiencies during today’s investigation. An exit interview was conducted and a Notice of Site Visit will be mailed to the licensee to post for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher Bello	TELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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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