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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153911851
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:26:15 AM

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
09/20/2022 and conducted by Evaluator Kari McWilliams
PUBLIC
COMPLAINT CONTROL NUMBER: 57-CC-20220920094922
FACILITY NAME:GREEN, KARYN FAMILY CHILD CAREFACILITY NUMBER:
153911851
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Karyn GreenTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared adult was living in the home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On November 3, 2022 Licensing Program Analyst (LPA) Kari McWilliams arrived at the facility to conduct an unannounced complaint investigation. The purpose of this inspection was to deliver findings regarding the above listed allegation. LPA McWilliams met with Licensee Karyn Green. A tour of the facility was given and a census was taken.

During the investigation LPA McWilliams completed thorough interviews with past and present parents and staff as well as completed multiple thorough facility inpsections.

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, no deficiencies are being cited. An exit interview was conducted with Licensee Karyn Green. Notice of Site Visit Form to be posted to parent's board and must remain posted for 30 days. Appeal Rights were provided to Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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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