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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423693
Report Date: 06/12/2023
Date Signed: 06/12/2023 01:02:16 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230504160250
FACILITY NAME:COOPER, SHA'NIECEFACILITY NUMBER:
013423693
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
06/12/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sha'niece CooperTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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9
Due to lack of supervision, the child's hair was pulled out
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
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13
On 06/12/2023 At 1:00PM Licensing Program Analyst (LPA) A. Curry conducted an unannounced subsequent complaint inspection and met with licensee, Sha’niece Cooper, to discuss the above allegations. The LPA previously toured the facility, made observations, reviewed facility records, and conducted interviews. The allegation is due to lack of supervision, the child's hair was pulled out. During the course of the investigation, it could not be determined that there was a lack of supervision that caused a child’s hair to be pulled out. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. This allegation is Unsubstantiated.

Exit interview conducted, appeal rights were given, and report was reviewed with the licensee Sha’niece Cooper.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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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