393610503-5-10-2019-03-CC-MMAA-BC9UE8-20190517153040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393610503
Report Date: 05/10/2019
Date Signed: 05/10/2019 09:48:16 AM

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
02/19/2019 and conducted by Evaluator Mary Ponce

COMPLAINT CONTROL NUMBER: 03-CC-20190219095136

FACILITY NAME:	MELEEN, DEBRA		FACILITY NUMBER:	393610503
ADMINISTRATOR:	MELEEN, DEBRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 346-5173
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	14	CENSUS: 10	DATE:	05/10/2019
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Debra Meleen		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility operating over capacity.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Mary Ponce and Marissa Soto met with licensee to deliver findings regarding the above allegation. It was alleged that staff cared for 16 children which is over the Large Family License Capacity. During the investigation, LPA conducted interviews, made observations, and collected pertinent documentation. Based on inconsistent information during interviews, there was not a preponderance of evidence to show that the allegation took place.

No Title 22 deficiencies were cited during today's inspection. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Mary Ponce	TELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2