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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393611423
Report Date: 11/03/2021
Date Signed: 11/03/2021 01:58:50 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
08/24/2021 and conducted by Evaluator Christopher Jackson
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20210824092048
FACILITY NAME:MORA, AMYFACILITY NUMBER:
393611423
ADMINISTRATOR:MORA,AMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 430-6184
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:14CENSUS: 12DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Amy MoraTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Licensee does not allow parent to enter and inspect the family child care home.
INVESTIGATION FINDINGS:
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On 11/03/21, Licensing Program Analyst (LPA) Christopher Jackson met with Licensee, Amy Mora to provide the finding for the above allegation. It was alleged that the” Licensee does not allow parents to enter and inspect the family child care home.” During the investigation process, LPA conducted interviews and obtained supporting information pertinent to the investigation. Interviews conducted revealed conflicting statements regarding the allegation. LPA learned that the licensee prefers to be informed if parents will be entering the home, however, statements taken did not corroborate that parents are denied entry.

Based on the information obtained throughout the course of this investigation 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.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 53-CC-20210824092048
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MORA, AMY
FACILITY NUMBER: 393611423
VISIT DATE: 11/03/2021
NARRATIVE
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No Title 22 deficiencies were cited. Exit interview was conducted. Appeal rights were printed and provided. Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2