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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 500318152
Report Date: 12/02/2020
Date Signed: 12/02/2020 04:58:50 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2020 and conducted by Evaluator Candis Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20200922091038
FACILITY NAME:WILLIAMS, PATTIFACILITY NUMBER:
500318152
ADMINISTRATOR:WILLIAMS, CLAUDE/PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 521-5889
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:14CENSUS: 8DATE:
12/02/2020
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Patti WilliamsTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee handled child roughly.
INVESTIGATION FINDINGS:
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On 12/02/2020, Licensing Program Analyst (LPA) Candis Rodriguez conducted a complaint inspection regarding the above allegation via tele-visit with Licensee Patti Williams.

LPA explained the purpose of the complaint inspection and took a census.
During the course of the investigation, LPA interviewed five parents, Licensee, Assistant, and five children. LPA reviewed facility files and a police report from Modesto Police Department. In an interview with Parent #2, Parent #2 stated her child, Child #2 witnessed Licensee do "something" but could not describe whether it was "a hit or a pat" to Child #1, which resulted in Child #1 crying.

In the police report, the responding officer asked Child #1 to show hard Licensee struck Child #1 with a pillow. The officer observed that Child #1 emulated hitting a pillow "extremely soft" and was "closer to a nudge rather than a striking blow." Also in the police report, the officer states Reporting Party did not believe Licensee did anything criminal or intended to hurt Child #1. (Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
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 2
Control Number 04-CC-20200922091038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: WILLIAMS, PATTI
FACILITY NUMBER: 500318152
VISIT DATE: 12/02/2020
NARRATIVE
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Based on interviews, police report review, and file review conducted, investigation could not reveal Licensee handled child roughly. Therefore, although allegation above may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Per the California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies are cited today. An exit interview was conducted with Licensee Patti Williams.



LPA advised Licensee to sign and return LIC 9099 and LIC 9099-C to Community Care Licensing.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Candis RodriguezTELEPHONE: (559) 341-4117
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020
LIC9099 (FAS) - (06/04)
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