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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 543910940
Report Date: 03/30/2022
Date Signed: 03/30/2022 10:58:25 AM

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
01/26/2022 and conducted by Evaluator Theresa Marquez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220126104850
FACILITY NAME:JACKSON, LOVELY FAMILY CHILD CAREFACILITY NUMBER:
543910940
ADMINISTRATOR:JACKSON, LOVELYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-8136
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:14CENSUS: 9DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lovely JacksonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not following proper COVID-19 mask guidance.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/30/2022, Licensing Program Analyst (LPA) Theresa Marquez conducted a complaint inspection and met with licensee, Lovely Jackson. Assistant Dionshynee Darby was also present. The purpose of this inspection is to provide complaint findings for the above allegation.

During the course of the investigation, LPA conducted interviews and a record review.
The investigation revealed that there is insufficient evidence to determine that licensee is not following proper COVID 19 mask quidance.
Although the allegations may have happened or are valid, there is not a preponderance of the evidence that violations occurred; therefore, the allegation is unsubstantiated.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited on this report. An exit interview was conducted with Lovely Jackson. A Notice of Site Visit is to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Theresa MarquezTELEPHONE: (559) 341-7123
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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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