393619906-11-26-2019-53-CC-SOGO-BJQ547-20191209183703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393619906
Report Date: 11/26/2019
Date Signed: 11/26/2019 10:50:54 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
09/19/2019 and conducted by Evaluator Charlotte Baney

COMPLAINT CONTROL NUMBER: 53-CC-20190919164032

FACILITY NAME:	GONZALES, VALENE		FACILITY NUMBER:	393619906
ADMINISTRATOR:	GONZALES, VALENE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 915-9786
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	14	CENSUS: 13	DATE:	11/26/2019
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Valene Gonzales		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Adult in the home inappropriately interacted with day care child.
Smoking on the premises

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Charlotte Baney and Chris Jackson met with licensee to provide the finding for the above allegations. During the investigation LPA conducted interviews, made observations and reviewed information. The complainant alleged adult in the home inappropriately interacted with day care child and that facility smelled like smoke. Based on the conflicting information obtained throughout the course of this investigation the above allegations could not be substantiated or dismissed. Although the allegations may have happened (or is valid), there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the finding is UNSUBSTANTIATED.

Based on interviews, observations, documentation, and other information gathered, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is unsubstantiated.
No Title 22 deficiencies were cited at time of visit. An exit interview was conducted in which the report was reviewed and discussed with licensee. Appeal rights were discussed, and a printed version was given to licensee.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte Baney	TELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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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