483009035-9-17-2021-01-CC-AHON-C7DSTA-20211001140910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 483009035
Report Date: 09/16/2021
Date Signed: 09/17/2021 10:51:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2021 and conducted by Evaluator Mary Trinh

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210818085648

FACILITY NAME:	CLAVERIE, KRISTI FCCH		FACILITY NUMBER:	483009035
ADMINISTRATOR:	CLAVERIE, KRISTI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 720-4417
CITY:	BENICIA	STATE: CA	ZIP CODE:	94510
CAPACITY:	14	CENSUS: 7	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	Kristi Claverie		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee is not providing a safe environment.

INVESTIGATION FINDINGS:

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

A follow-up complaint investigation visit was made today by Licensing Program Analyst (LPA), Mary Trinh to deliver complaint investigation findings. This complaint was investigated by the Department’s Investigations Branch (IB) Investigator, S. Guerra in collaboration with the Benicia Police Department and Solano County Child Welfare Services. It was alleged that the licensee is not providing a safe environment. During the complaint investigation, interviews were conducted with the licensee, staff, children, and parents. Forensic interviews with C1 or C2 were not conducted due to lack of parental consent, and a physical examination of C2 by a medical professional was not conducted due to lack of parental consent. Based on available information, there is not a preponderance of evidence to support the allegation, therefore, the allegation is unsubstantiated.
All licensing reports are public information and must be made available upon request for at least three years. This report was read and reviewed with the licensee. There were no Title 22 deficiencies cited during today's inspection. Appeal rights were provided. The Notice of Site Visit shall be posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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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