<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 367700046
Report Date: 01/12/2021
Date Signed: 01/13/2021 01:47:52 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/19/2020 and conducted by Evaluator Steven Montoya
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20201119151613
FACILITY NAME:JENSEN FAMILY CHILD CAREFACILITY NUMBER:
367700046
ADMINISTRATOR:JENSEN, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 963-6114
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY:14CENSUS: 5DATE:
01/12/2021
UNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Maria Jensen LicenseeTIME COMPLETED:
11:59 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation 3: Licensee does not spend a sufficient amount of time in the home
Allegation 4: Licensee is operating over capacity
Allegation 5: Children nap on the floor
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This Investigative finding was amended on 01-13-2021 in order to change to public. On November 20, 2020, Licensing Program Analyst (LPA) Steven Montoya conducted a virtual visit to initiate a complaint investigation concerning the above allegations. LPA observed 5 children in care.The investigation consisted of interviews with Licensee, 2 children and a parent. LPA inspected the facility, reviewed sign in and out records.

Concerning the allegation of Licensee does not spend a sufficient amount of time in the home, interviews conducted revealed Licensee is main day care provider and she is away from the home only to run errands such as xxx. Concerning the allegation of the Licensee operates out of capacity, LPA reviewed sign in and out sheets and interviewed other relevant complaint parties and there is no evidence to corroborate the allegation. Concerning the allegation of children nap on the floor, LPA observed children laying on cots/mats with blankets during nap time.

Based on the information obtained during the investigation, the above allegations have been deemed to be unsubstantiated. Continued on C page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 12-CC-20201119151613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JENSEN FAMILY CHILD CARE
FACILITY NUMBER: 367700046
VISIT DATE: 01/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
An exit interview was conducted with Licensee and a copy of this report was sent to Licensee via email. LPA advised Licensee to review, sign and return the Complaint Investigation Report to LPA.

Exit interview conducted.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2