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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 367700469
Report Date: 06/10/2025
Date Signed: 06/10/2025 10:31:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 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
04/25/2025 and conducted by Evaluator Sherell Braddock
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20250425101031
FACILITY NAME:CHURCHILL FAMILY CHILD CAREFACILITY NUMBER:
367700469
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
06/10/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jennifer Churchill- LicenseeTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Uncleared adult in home
INVESTIGATION FINDINGS:
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On Tuesday, June 10, 2025 Licensing Program Analysts (LPA) Braddock conducted an unannounced complaint inspection to deliver findings on the above allegations. LPA met with Licensee Jennifer Churchill and toured the facility. At the time of the visit, there were 5 children present with 1 staff.

During the investigation, LPA conducted confidential interviews, reviewed facility files and records and toured the facility. The following allegation were investigated: Uncleared adult in home.

Per licensee, the adult in question lived in her home prior to becoming a licensed Family childcare home. Per licensee the uncleared adult moved from her home in January when their background did not pass CPMB Guardian. Per licensee, licensee’s brother visited her home during the month of April from out of town.

Based on information obtained, and LPA observations the above allegation is deemed Unsubstantiated . An Unsubstantiated finding means, the above allegations may have happened or are valid, but there is not a preponderance of evidence to prove or disprove that the alleged violations occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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 12-CC-20250425101031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CHURCHILL FAMILY CHILD CARE
FACILITY NUMBER: 367700469
VISIT DATE: 06/10/2025
NARRATIVE
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This inspection was conducted in person. LPA read the report with licensee and provided a copy of the report, Appeal Rights, and a Notice of Site Visit was given and must be posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2