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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409051
Report Date: 12/09/2022
Date Signed: 12/09/2022 02:54:22 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
09/16/2022 and conducted by Evaluator Nyeesha Blount
COMPLAINT CONTROL NUMBER: 02-CC-20220916105737
FACILITY NAME:NASCIMENTO, LUCIARAFACILITY NUMBER:
073409051
ADMINISTRATOR:NASCIMENTO, LUCIARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 240-1378
CITY:PINOLESTATE: CAZIP CODE:
94564
CAPACITY:14CENSUS: 6DATE:
12/09/2022
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:NASCIMENTO, LUCIARATIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Personal Rights ~ Day care child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Nyeesha Blount and Licensing Program Manager Mayla Mendoza conducted an unannounced complaint Investigation inspection, LPA and LPM met with Licensee Nascimento, Luciara and (2) assistants,Present during the visit were,(3) Infants and (3) Preschool children. A health and safety inspection was conducted.

During the course of investigation LPA interviewed the licensee, staff, parents. Interviews with assistants advised the child was seen trying to climb the fence and may have hurt himself, but they did not see the child substain any injuries. Based on interviews conducted LPA is unable to determine if the alleged incident occurred. 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 deemed unsubstantiated.
Unsubstantiated
Estimated Days of Completion: 60
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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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