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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623702
Report Date: 10/28/2022
Date Signed: 10/28/2022 01:42:02 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2022 and conducted by Evaluator Gagandeep Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220930155438
FACILITY NAME:ELIX, MAYESHAFACILITY NUMBER:
343623702
ADMINISTRATOR:ELIX, MAYESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 743-2129
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:14CENSUS: 10DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mayesha ElixTIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
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9
Licesee did not notify landlord of intent to operate a family child care home.
INVESTIGATION FINDINGS:
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2
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9
10
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13
Licensing Program Analyst (LPA) Gagandeep Singh met with the staff, Mayesha Elix, to deliver the complaint findings for the above allegation. Purpose of the inspection was explained.

The licensee was alleged that licensee did not notified her landlord intent to operate a family child care home on the premises. During the investigation, LPA interviewed the licensee. Licensee stated that licensee sent the Property Landlord Notification form (LIC9151) to landlord at the address provided on lease agreement. Licensee provided a copy of the form that was mailed to the landlord. Per licensee, as the form was sent through regular mail, licensee does not have confirmation of receipt of the form from the landlord. During the investigation, LPA confirmed that licensee understands and agree to not provide care to more than 12 children, until she receive the Landlord consent form (LIC9149) signed by landlord. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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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