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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376623793
Report Date: 10/29/2019
Date Signed: 10/29/2019 10:50:20 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
08/07/2019 and conducted by Evaluator Samantha Salunga
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20190807153054
FACILITY NAME:RAVEN, TIFFANIE FAMILY CHILD CAREFACILITY NUMBER:
376623793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/29/2019
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Tiffanie RavenTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
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7
8
9
Provider is sedating children in care.
Provider is forcing children to go to sleep.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Samantha Salunga completed an unannounced inspection for the purpose of delivering the finding for the above allegations.Upon arrival, LPA met with Licensee, Tiffanie Raven. Also present was Licensee's own two children and one day care child. Dantae Jackson was also present. During the course of the investigation, analyst conducted interviews with staff, children and parents. LPA obtained conflicting statements throughout the investigation. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, there for the allegations are UNSUBSTANTIATED. An exit interview was conducted with Licensee. LPA provided and reviewed copy of appeal rights (LIC 9058 01/16) to Licensee and her signature on this form acknowledges receipt of these rights. No deficiencies observed in the areas inspected during today's visit. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Licensee notice of site visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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