376618546-10-26-2021-10-CC-CMAZ-C8UPQC-20211117103053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376618546
Report Date: 10/26/2021
Date Signed: 10/26/2021 12:49:56 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 STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/01/2021 and conducted by Evaluator James Wilkerson

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20211001165934

FACILITY NAME:	O'NEILL, KELLIE FAMILY CHILD CARE		FACILITY NUMBER:	376618546
ADMINISTRATOR:	KELLIE O'NEILL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 214-6021
CITY:	VISTA	STATE: CA	ZIP CODE:	92081
CAPACITY:	14	CENSUS: 12	DATE:	10/26/2021
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Kellie O'Neill		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Child sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) James Wilkerson & Joanne Domingo arrived at this facility to conclude an investigation into the above allegation. LPAs toured the facility and conducted census. A initial visit was conducted on 10/07/21 and extended at that time. During the course of this investigation interviews were conducted with three staff and two children. LPAs reviewed documentation as well. There is an allegation that a child received injuries at this facility that are unexplained. LPAs are unable to prove or disprove that any unexplained injuries happened at this facility or outside the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, A Notice of Site Visit posted and a copy of this report was provided to Ms. O'Neill on this date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James Wilkerson	TELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021

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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