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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423006
Report Date: 08/22/2022
Date Signed: 08/22/2022 03:45:28 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2022 and conducted by Evaluator Sidney Cortez
COMPLAINT CONTROL NUMBER: 52-CC-20220818123641

FACILITY NAME:PENA RAMIREZ, JOSEFACILITY NUMBER:
013423006
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
08/22/2022
UNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Carolina RamirezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On Aug 22, 2022 , Licensing Program Analyst (LPA) Sidney Cortez conducted an unannounced complaint site inspection. LPA Cortez met with licensee and staff to investigate the allegation.

Allegation was under the category of: Personal Rights. LPA took a tour of the facility for a health and safety inspection. Present during the inspection was the licensee and 2 school age children and one infant.

LPA Cortez requested and obtained a copy of the facility roster and personnel report. LPA conducted interviews with the licensee.

Based on the interviews conducted, files obtained, and observation, the allegation UNSUBSTANTIATED meaning there was no preponderance of evidence to prove the alleged violation occurred.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022
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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