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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393622570
Report Date: 07/20/2023
Date Signed: 07/20/2023 12:10:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/12/2023 and conducted by Evaluator Mariya Melnichuk
COMPLAINT CONTROL NUMBER: 53-CC-20230512161123
FACILITY NAME:MARTIN, LAKISHAFACILITY NUMBER:
393622570
ADMINISTRATOR:MARTIN, LAKISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 271-4228
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:14CENSUS: DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Licensee: Lakisha MartinTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
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9
Licensee no longer resides in the facility
INVESTIGATION FINDINGS:
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2
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5
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9
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13
Licensing Program Analysts (LPA’s) Mariya Melnichuk and Lauren Scott met with Licensee, Lakesha Martin to deliver the findings of the complaint investigation regarding the above allegation.
During the course of the investigation, LPA Melnichuk conducted interviews and obtained reports. It was alleged the licensee no longer lives at the facility.

Based on the information obtained throughout the course of this investigation the above allegation could not be substantiated or dismissed. Interviews revealed that although the licensee was away from the facility for some time, there is no direct evidence to suggest that the licensee no longer lives in the home. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the finding is UNSUBSTANTIATED.

Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Mariya MelnichukTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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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