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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426208408
Report Date: 10/16/2020
Date Signed: 10/16/2020 12:02:54 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/23/2020 and conducted by Evaluator Sylvia Mendoza-Ceja
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20200723150756
FACILITY NAME:KOWALEWSKI FAMILY CHILD CAREFACILITY NUMBER:
426208408
ADMINISTRATOR:SHELLY KOWALEWSKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 737-9872
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 0DATE:
10/16/2020
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shelly KowalewskiTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee hit child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an unannounced tele-inspection due to COVID-19 State of Emergency. LPA advised licensee that due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection will occur. LPA confirmed with licensee that she has video capabilities with her cell phone via Facetime to conduct the tele-inspection.

LPA S. Mendoza-Ceja met with Licensee Shelly Kowalewski. The purpose of the tele-inspection is to conclude the complaint investigation of the above allegation. The complaint was initiated on 07/28/2020. The investigation included obtaining the child care roster, obtaining complainant's statement, interviewing Licensee, and parents of children in care.

Complainant stated child #13 made the above statement. Complainant declined an interview for child #13.

Licensee stated she has never hit a child, not even her own children. Licensee stated "I treat the children as if they are my own children". Licensee stated she has worked very hard to establish her day care and obtain Accreditation. Licensee stated she has been Accredited for 6 years.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
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 4
Control Number 17-CC-20200723150756
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KOWALEWSKI FAMILY CHILD CARE
FACILITY NUMBER: 426208408
VISIT DATE: 10/16/2020
NARRATIVE
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5
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7
8
9
10
11
12
13
14
15
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17
18
19
20
21
22
23
24
25
26
27
28
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31
32
Parents interviewed stated indicated they are satisfied with the care their children receive and did not corroborate the above allegation.

The above allegation is unsubstantiated, based on LPA's interviews with Licensee, complainant, parents, and record review. Although these allegations may have occurred, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore, the allegation is unsubstantiated.

An exit interview was conducted with Licensee Shelly Kowalewski. This report will be sent to the Licensee via email with a read receipt for confirmation of receipt of the email, Licensee shall sign and return via email to LPA S. Mendoza-Ceja.

Licensee shall post the "Notice of Site Visit for 30 days".
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 4