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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418150
Report Date: 10/21/2021
Date Signed: 10/21/2021 12:36:40 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2021 and conducted by Evaluator Denise Gibbs
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20210909092441
FACILITY NAME:MOORE FAMILY CHILD CAREFACILITY NUMBER:
197418150
ADMINISTRATOR:MOORE, ADRIENNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 240-5655
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:14CENSUS: 4DATE:
10/21/2021
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Adrianne Moore, LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal Rights- Adults in home are engaging in verbal altercations in the presence of day care children
INVESTIGATION FINDINGS:
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This was a complaint inspection conducted by Denise Gibbs, Licensing Program Analyst (LPA) on 10/21/21 at 11:45AM. This complaint was conducted with Adrianne Moore, Licensee, for the purpose of delivering findings.

There were four children and four adults present when the visit began.

During the course of this investigation, LPA conducted interviews with adults and staff. All pertinent documentation was collected. Per Licensee and staff the incident in question happened early in the morning before daycare children arrived. This was a family matter that took place outside the daycare on the sidewalk. The child in question was not part of the daycare. Other interviews conducted provided no disclosures regarding the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove
the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. ------------------Page 1
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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 54-CC-20210909092441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 197418150
VISIT DATE: 10/21/2021
NARRATIVE
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No deficiencies will be cited today 10/21/21.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Adrianne Moore, during which appeal rights were explained. -----------PAGE 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2