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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 543910535
Report Date: 04/13/2022
Date Signed: 04/13/2022 03:30:25 PM

Unsubstantiated


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
02/08/2022 and conducted by Evaluator Jessika Thompson
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220208111339
FACILITY NAME:VALDEZ, ANNA FAMILY CHILD CAREFACILITY NUMBER:
543910535
ADMINISTRATOR:VALDEZ, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 740-0579
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:14CENSUS: 1DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Anna Valdez- LicenseeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child was injured while in care
Uncleared adult left to supervise children
Child was not adequately fed while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/13/22 Licensing Program Analyst (LPA) Jessika Thompson arrived at the facility to conduct an unannounced complaint inspection. The purpose of this inspection was to gather information to investigate the above listed allegations. LPA explained the allegations to Licensee Anna Valdez, and a census was taken. Throughout the course of this investigation LPA interviewed staff, parents, and reviewed facility records.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited.

Exit interview conducted with Licensee. The licensee was provided a copy of their appeal rights (LIC9058 12/15) and their signature on this form acknowledges receipt of this form. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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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