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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393609167
Report Date: 06/03/2024
Date Signed: 06/03/2024 12:10:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2024 and conducted by Evaluator Lauren Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20240513092655
FACILITY NAME:AVILA, BARBARAFACILITY NUMBER:
393609167
ADMINISTRATOR:BARBARA AVILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 814-8945
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:14CENSUS: 1DATE:
06/03/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:licensee, Barbara AvilaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared adults living in the home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lauren Scott met with licensee, Barbara Avila, to deliver the findings of the complaint investigation regarding the above allegation.
During the course of the investigation, LPA Scott conducted interviews, and obtained information pertaining to allegation. It was alleged that uncleared adults were living in the home. Based on information provided by licensee, all residents had an eligible background clearance. Interviews conducted with parents revealed most were unaware of residents in the home.
Based on the information obtained throughout the course of this investigation, and conflicting information obtained from parents and licensee, the above allegation could not be substantiated or dismissed. 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 finding is UNSUBSTANTIATED.
Exit interview was conducted. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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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