543911208-11-12-2021-04-CC-DLEN-C92U4K-20211123141516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 543911208
Report Date: 11/12/2021
Date Signed: 11/12/2021 01:29:06 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
08/30/2021 and conducted by Evaluator Jessika Thompson

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20210830104045

FACILITY NAME:	LEE, MONICA FAMILY CHILD CARE		FACILITY NUMBER:	543911208
ADMINISTRATOR:	LEE, MONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(559) 679-2150
CITY:	VISALIA	STATE: CA	ZIP CODE:	93291
CAPACITY:	14	CENSUS: 6	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Monica Lee- Licensee		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Child sustained unexplained injury while in care

INVESTIGATION FINDINGS:

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11/12/21 Licensing Program Analyst (LPA) Jessika Thompson arrived at facility to conduct an unannounced complaint inspection. The purpose of this inspection was to gather information to investigate the above allegation. LPA met with Licensee Monica Lee. LPA explained the allegation to Licensee and a census was taken. Throughout the course of this investigation, LPA interviewed staff and parents, and reviewed facility records.

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

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency was cited. An exit interview was conducted with Licensee and Licensee was provided a copy of her appeal rights (LIC9058 12/15) and her signature on this form acknowledges receipt of this form. A Notice of Site Visit Form was provided and must remain posted on parent's board for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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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