376620900-6-7-2021-20-CC-CGRY-C3TVKW-20210609163058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376620900
Report Date: 05/27/2021
Date Signed: 06/07/2021 07:25:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2021 and conducted by Evaluator Adrian Castellon

COMPLAINT CONTROL NUMBER: 20-CC-20210312093025

FACILITY NAME:	BACKUS, AUTUMN FAMILY CHILD CARE		FACILITY NUMBER:	376620900
ADMINISTRATOR:	AUTUMN BACKUS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 869-4177
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	14	CENSUS:	DATE:	05/27/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Autumn Backus		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Licensee yells at children in care

INVESTIGATION FINDINGS:

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On 05/27/21 at 2:30pm, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced teleinspection to deliver complaint findings for the above allegation. Due to Covid-19 state of emergency, this inspection was conducted via teleconference. LPA Castellon met with licensee Autumn Backus. It was alleged that licensee yells at children in care.

During the course of the investigation, LPA Castellon conducted unannounced inspections. Interviews were conducted with daycare parents (4), facility staff (4), and children in care (5). Due to conflicting statments obtained during the course of the investigation , the above allegation is deemed to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged allegation occurred. Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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 20-CC-20210312093025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BACKUS, AUTUMN FAMILY CHILD CARE	FACILITY NUMBER: 376620900
	VISIT DATE: 05/27/2021

NARRATIVE

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A copy of today's report, Notice of Site Visit and appeals rights were emailed to the licensees. An exit interview was conducted with the licensee and licensee stated that they understood. Licensee were advised acknowledgement of receipt of the report is to be received within twenty-four hours. Covid-19 state of emergency read receipt notification will be used in palce of licensees' signatures. Notice of Site Visit should be posted for 30 days from today's date.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC9099 (FAS) - (06/04)

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