360918948-3-18-2022-09-CC-KWIS-CD729B-20220404171138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360918948
Report Date: 03/17/2022
Date Signed: 03/18/2022 08:52:03 AM

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
01/07/2022 and conducted by Evaluator Laura Mejorado

COMPLAINT CONTROL NUMBER: 09-CC-20220107100838

FACILITY NAME:	MIELEWCZYK FAMILY CARE		FACILITY NUMBER:	360918948
ADMINISTRATOR:	MIELEWCZYK, KRYSTYNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 875-0560
CITY:	COLTON	STATE: CA	ZIP CODE:	92324
CAPACITY:	12	CENSUS: 2	DATE:	03/17/2022
		UNANNOUNCED	TIME BEGAN:	11:47 AM
MET WITH:	Krystyna Mielewczyk		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Personal Rights - Day care home does not provide a safe environment for day care children.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Laura Mejorado and Destinee Hogue arrived at the facility to deliver the findings of this complaint investigation which was initiated on 01/13/2022. LPAs met with Licensee, Krystyna Mielewczyk, toured the facility, took census, and discussed the following.

During the investigation, LPA made observations, reviewed pertinent documentation and conducted interviews with pertinent parties.

It was alleged, day care home does not provide a safe environment for day care children.

LPA investigated the allegation and gathered the following information:

See LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura Mejorado	TELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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 09-CC-20220107100838

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: MIELEWCZYK FAMILY CARE	FACILITY NUMBER: 360918948
	VISIT DATE: 03/17/2022

NARRATIVE

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It was alleged, in the first week of January 2022 the day care home got a new dog who was becoming violent by barking and attempting to bite people. Allegedly, these concerns were brought to the attention of the Licensee. Licensee denied these allegations stating they have not had any complaints about the dogs and that they found the new dog, nurtured it, and are looking for a new home. During both visits, Licensees dogs have been kept in a bedroom away from the children and day care area. While conducting interviews, it was disclosed the dogs are usually outside but there have not been any issues and/or injuries concerning the facility’s dogs.

Based on information obtained during this investigation, through interviews and observations conducted, the review of pertinent documentation, and after receiving conflicting information, the allegation is UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred.

An exit interview was conducted with the Licensee, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued.

The Notice of Site Visit (LIC 9213) shall be 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.

A copy of this report must be made available for the next three years.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura Mejorado	TELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC9099 (FAS) - (06/04)

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