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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846207
Report Date: 04/17/2023
Date Signed: 04/17/2023 02:56:13 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/01/2023 and conducted by Evaluator Karrene Turner
COMPLAINT CONTROL NUMBER: 09-CC-20230201140521
FACILITY NAME:AHLSTRAND FAMILY CHILD CAREFACILITY NUMBER:
334846207
ADMINISTRATOR:AHLSTRAND, DEVIN LEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 651-1295
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:14CENSUS: 6DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Devin Ahlstrand, LicenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Personal Rights - Child was not properly secured in a restraing system while being tansported in a vehicle
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kay Turner and Raymond Moore Jr arrived at the facility to provide investigation findings of the above allegation. LPA Turner met with the Licensee, Devin Ahlstrand, and stated the purpose of today’s inspection. The facility was toured and a census was taken. During the initial inspection on 02/10/2023, LPA Turner interviewed pertinent parties and obtained relevant documents related to the investigation.

The allegation alleged a daycare child was not properly secured in a restraint system while being transported in a vehicle. It was reported that a child at the facility was transported from their school to the facility without having a carseat in the facility vehicle. During the course of the LPA’s investigation, the staff member confirmed transporting the child from school to the facility without a carseat. Furthermore, the staff member disclosed there were at least 2-3 other times in transporting the child that a carsear was not used under their supervision.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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 3
Control Number 09-CC-20230201140521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
VISIT DATE: 04/17/2023
NARRATIVE
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Based on all the information obtained from pertinent parties, documentation, records review during inspection, the department has determined the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

See LIC 9099-D for deficiencies.

Exit interview was conducted with the licensee, Devin Ahlstrand. A copy of this report, Notice of Site Visit, and Appeal Rights were provided A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. A copy of this report must be made available to the public for three years upon request.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230201140521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: AHLSTRAND FAMILY CHILD CARE
FACILITY NUMBER: 334846207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2023
Section Cited
CCR
102414(k)
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Operation of a Family Child Care Home:
All vehicle occupants must be secured in an appropriate restraint system.

This requirement was not met as evidenced by...


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The licensee agrees to submit a memo of understanding of the regulation and provide the Department with a plan as to how the facility will remain in complaince with the regulation.
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Based on interviews completed at the facility on 02/10/2023, staff admitted to transporting a child from school to the facility multiple times without the appropriate carseat. This poses an immediate risk to the health, safety or personal rights to persons 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: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3