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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198400256
Report Date: 11/23/2021
Date Signed: 11/24/2021 02:04:57 PM

Substantiated


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
11/15/2021 and conducted by Evaluator Alicia Mooberry
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20211115125224
FACILITY NAME:FAUNTLEROY FAMILY CHILD CAREFACILITY NUMBER:
198400256
ADMINISTRATOR:DIANN FAUNTLEROYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 413-5827
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:14CENSUS: 0DATE:
11/23/2021
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Diann Fauntleroy, via phone callTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Licensee moved and is no longer living at the facility address.
INVESTIGATION FINDINGS:
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This complaint inspection was conducted by Licensing Program Analyst (LPA) Alicia Mooberry. LPA arrived at the facility at 1:57pm. LPA was unable to enter the home due to a locked gate. LPA observed a car in the driveway but was unable to see any activity inside the home.
At conducted a phone interview with licensee, Diann Fauntleroy, who confirmed that they are no longer living in the home. Licensee failed to report to the department changes to their status. Licensee stated they will surrender the license.

Based on licenee's admission that they have moved from the facility, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The licensee was unable to sign this report. A copy of this report will be sent to licensee's new address and this facililty will be closed.

Exit interview conducted with Licensee, Diann Fauntleroy.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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-20211115125224
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: FAUNTLEROY FAMILY CHILD CARE
FACILITY NUMBER: 198400256
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2021
Section Cited
CCR
102416.2(a)(2)
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The licensee shall report the following information the Department... within the Department's next business day and during normal working hours (8am to 5pm). Any change in household composition including adults moving in or out of the home...
This requirement is not met as evidenced by:
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Licensee has forfeited facility license.
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Based on verbal and written confirmation from the licensee received on 11/23/21 that they moved out of the licensed home on 11/1/21. The licensee failed to report the move to the department withing the required timeline. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2