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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274416764
Report Date: 02/01/2023
Date Signed: 02/01/2023 10:21:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
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 Elizabeth Larios
COMPLAINT CONTROL NUMBER: 07-CC-20220920110849
FACILITY NAME:ROCHA, JOANNAFACILITY NUMBER:
274416764
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
02/01/2023
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Joanna Rocha TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Child suffered unexplained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Elizabeth Larios conducted an unannounced complaint investigation visit to deliver investigation finding. LPA met with Licensee, Joanne Rocha explained the purpose of today's visit was to deliver the investigation finding for the above allegation.

Investigation Bureu Investigator, Maria Barragan, conducted interviews (with parents, staff, and children), reviewed pertinent documents (such as child file and roster), and made facility observations in relation to the above allegation. Based on the available evidence, it is concluded that although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The allegations is thus UNSUBSTANTIATED.

As a result of this investigation, no deficiencies were cited. Exit interview was conducted and the report was reviewed with Joanna Rocha .

====CONTINUE ON LIC 9099-C====
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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 07-CC-20220920110849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROCHA, JOANNA
FACILITY NUMBER: 274416764
VISIT DATE: 02/01/2023
NARRATIVE
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A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2