364845744-5-4-2021-09-CC-GSEA-C2RKAP-20210506074412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364845744
Report Date: 04/29/2021
Date Signed: 05/04/2021 06:32:25 PM

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
02/17/2021 and conducted by Evaluator Diana Brasel

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20210217164646

FACILITY NAME:	FOREST FAMILY CHILD CARE		FACILITY NUMBER:	364845744
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	04/29/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Joyce Forest Licensee		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Licensee yelled at children in care.
Licensee used inappropriate language in the presence of children in care.
Licensee left children unsupervised.
Licensee threatened children in care.

INVESTIGATION FINDINGS:

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On the above date and time, Licensing Program Analyst (LPA) Diana Brasel conducted a tele-inspection visit with the licensee, due to COVID-19 and DPH guidelines of social distancing. The purpose of the tele-inspection visit is to deliver the concluded findings for the above allegations. LPA reviewed the concluded complaint findings with the licensee.

This investigation was initiated on 02/26/2021, at which time it was extended to gather additional information. Since then, written statements were obtained, documents were provided, and additional interviews were conducted. The following information was received and obtained:

1. It was alleged that “Licensee yelled at children in care.” The licensee denies the allegation.
2. It was alleged that “Licensee used inappropriate language in the presence of children in
care.” The licensee denies the allegation.
--Continued on LIC9099C--

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

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-20210217164646

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: FOREST FAMILY CHILD CARE	FACILITY NUMBER: 364845744
	VISIT DATE: 04/29/2021

NARRATIVE

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3. It was alleged that “Licensee left children unsupervised.” The licensee denies the allegation.
4. It was alleged that “Licensee threatened children in care.” The licensee denies the allegation.

Although the Licensee denies the allegation, conflicting information was obtained during the investigation from what was alleged in the complaint. The Department has investigated the above allegations and although they may have happened or been valid, there is not a preponderance of the evidence to prove the alleged allegations occurred. The Department’s finding is the allegations are unsubstantiated.

LPA contacted the licensee to review the report. This report will be sent via email to the provided email address with an attached read receipt. A copy of the LIC 9058 and a Notice of Site visit will be sent via email along with the report. The read receipt will be used in lieu of the signature on the report. All reports shall be maintained for three years.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC9099 (FAS) - (06/04)

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