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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409255
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:14:08 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
07/07/2023 and conducted by Evaluator Cherie Acosta
COMPLAINT CONTROL NUMBER: 02-CC-20230707140516
FACILITY NAME:PERUMAL, SHEELAFACILITY NUMBER:
073409255
ADMINISTRATOR:PERUMAL, SHEELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 315-0321
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 1DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sheela PerumalTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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5
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8
9
Child sustained a head injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced visit to deliver finding for the above allegation. LPA met with licensee Sheela Perumal. Licensee's minor son was present during the visit, there were no children in care today.

The above allegation was investigated by Community Care Licensing Investigations Branch. Based on interviews which were conducted, the investigator was not able to determine if a child received a head injury while in care.
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.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Sheela Perumal
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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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