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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700021
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:01:56 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
05/25/2021 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20210525122135
FACILITY NAME:GRIJALVA FAMILY CHILD CAREFACILITY NUMBER:
197700021
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
06/23/2021
UNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Brigitte GrijalvaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Care providers did not adequately supervise day care children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/23/2021 Licensing Program Analyst (LPA) Heath conducted a follow-up complaint inspection to the Grijalva Family Child Care Home. LPA Heath spoke with Licensee, Brigitte Grijalva for the purpose of delivering the findings for the above complaint allegation. There are 8 child care children present.

During the course of investigating this allegation, LPA Heath conducted interviews with parents, children, licensee, and assistant. Based on interviews conducted with parents and children, and Licensee statement the above, it was determined that the allegation may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiency cited at this time.

An exit interview was conducted, a copy of this report, appeal rights, and notice of site visit are discussed and emailed to the Licensee for licensee signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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