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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376620900
Report Date: 06/18/2021
Date Signed: 06/19/2021 11:20:14 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
04/07/2021 and conducted by Evaluator Adrian Castellon
COMPLAINT CONTROL NUMBER: 20-CC-20210407142020
FACILITY NAME:BACKUS, AUTUMN FAMILY CHILD CAREFACILITY NUMBER:
376620900
ADMINISTRATOR:AUTUMN BACKUSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 869-4177
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:14CENSUS: 9DATE:
06/18/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brianna GodoyTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility is over capacity

Daycare children are locked in a room
INVESTIGATION FINDINGS:
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On 06/17/21 at 10:00am, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced complaint inspection to deliver complaint findings for the above allegations. LPA Castellon met withassistant Brianna Godoy and discussed the purpose of the inspection. It was alleged that facility is over capacity and hildren are locked in a room. LPA Castellon conducted a staff interview and child interview on this date.

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 (4). Licensee Backus submitted five weeks worth of sign in and out sheets and several unannounced inspection reports with a food nutrition program, which detail the number of children in care at the time of the inspection. Due to conflicting statments obtained during the course of the investigation and a review of documents submitted, the above allegations are 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 GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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-20210407142020
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: 06/18/2021
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. Notice of Site Visit should be posted for 30 days from today's date.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC9099 (FAS) - (06/04)
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