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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103911593
Report Date: 03/30/2023
Date Signed: 03/30/2023 02:55:49 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/22/2023 and conducted by Evaluator Nancy Her
PUBLIC
COMPLAINT CONTROL NUMBER: 57-CC-20230222085545
FACILITY NAME:CAVAZOS, DALILA FAMILY CHILD CAREFACILITY NUMBER:
103911593
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Dalila CavazosTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
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5
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7
8
9
Licensee left infant in a soiled diaper for an excessive amount of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/30/2023 Licensing Program Analysts (LPAs) Nancy Her and Martha De Haro conducted an unannounced complaint investigation to deliver the findings regarding the above allegation. LPAs met with Licensee Dalila Cavazos who accompanied LPAs during tour of the facility. LPAs explained the allegation and a census taken. During the course of the investigation, LPAs interviewed Licensee and witnesses, and reviewed facility records.

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 UNSUBSTANTIATED.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.
Exit interview conducted and report was reviewed with the facility representative Dalila Cavazos.
A Notice of Site Visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Nancy Her
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
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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