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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197417757
Report Date: 09/01/2023
Date Signed: 09/01/2023 12:47:29 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/27/2023 and conducted by Evaluator Justeene Tamayo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20230627123301
FACILITY NAME:KELLY FAMILY CHILD CAREFACILITY NUMBER:
197417757
ADMINISTRATOR:KELLY,BARBARA & LEOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 940-3366
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 5DATE:
09/01/2023
UNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Barbara Kelly, LicenseeTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Allegation:

Personal Rights-Daycare child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
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On 09/01/23 Licensing Program Analyst (LPA) Justeene Tamayo conducted and unannounced visit to Kelly Family Child Care today for the purpose of concluding the above complaint allegation. Upon arrival to the facility, LPA was greeted by licensee, Barbara Kelly and the nature of the visit was discussed. LPA observed 3 infants and 2 preschool children, along with assistant #1 and assistant #2.

During interviews with licensee and assistant #1, it was revealed child #1 did not have any bite marks when leaving the facility. LPA obtained video footage of child #1 where marks were not physically observed, and child #1 did not show any distress in the video while leaving the facility.

Please see LIC-9099C for additional information.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 12-CC-20230627123301
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KELLY FAMILY CHILD CARE
FACILITY NUMBER: 197417757
VISIT DATE: 09/01/2023
NARRATIVE
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Based on the information provided, the above allegation is rendered unsubstantiated at this time. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegation occurred.

An exit interview was conducted, a copy of this report, appeal rights, and a notice of site visit report was provided to the licensee.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2