393610444-10-13-2021-53-CC-JSMH-C8EVSF-20211103164127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393610444
Report Date: 10/13/2021
Date Signed: 10/13/2021 03:16:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator Jeevun Birk

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20210622144030

FACILITY NAME:	AMEZCUA, PATRICIA		FACILITY NUMBER:	393610444
ADMINISTRATOR:	AMEZCUA, PATRICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 951-0892
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 5	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Patricia Amezcua		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights - Inappropriate interactions occurred between children in home

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
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12
13

On 10/13/2021 at 2:50 PM Licencing Program Analyst (LPA) Jeevun Birk-Miller conducted an unannounced complaint inspection and met with Licensee, Patricia Amezcua to deliver the finding for the above allegation. It was alleged that due to lack of supervision Child#1 (C1) engaged in inapproriate interactions with Child #2 (C2) on multiple occassions. Investigator Juan Barajas from the Department’s Investigations Branch conducted the investigation. Investigator Barajas conducted interviews with staff, parents, and daycare children. Interviews with staff indicated that children are never left unsupervised and the allegation could not have occurred. Information from the interviews were inconsistant. 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 finding is unsubstantiated. An exit interview was conducted. A Notice of Site Visit was given and posted. This shall be posted for 30 days. Appeal rights were printed and provided.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun Birk	TELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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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