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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 553622097
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:29:19 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2021 and conducted by Evaluator Justin L Denton
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210701105342
FACILITY NAME:LIEDTKE, JESSICAFACILITY NUMBER:
553622097
ADMINISTRATOR:LIEDTKE, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 288-9437
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY:14CENSUS: 13DATE:
07/27/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jessica LiedtkeTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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9
Provider handled in rough manner.
INVESTIGATION FINDINGS:
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2
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13
Licensing Program Analyst (LPA) Justin Denton conducted an unannounced inspection at the above facility to deliver the finding for the above complaint allegation. During the inspection, LPA met with Licensee Jessica Liedtke. Also present were Liedtke's mother and her husband.

The Department received a report alleging that a provider in Liedtke's home handled a child in a rough manner. Documents were obtained and interviews were conducted on 7/27/21, including two confidential interviews. Roster was obtained to verify ages of children in the licensee's care. Information obtained during interviews did not provide sufficient evidence that a provider handled a child in a rough manner.

Based on interviews, observations, documentation, and other information gathered, there was not a preponderance of evidence to prove or negate the allegation, therefore the allegation is unsubstantiated An exit interview was conducted. This report and appeal rights were provided to the licensee.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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