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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393620016
Report Date: 06/05/2023
Date Signed: 06/05/2023 03:52:47 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
03/08/2023 and conducted by Evaluator Mariya Melnichuk
COMPLAINT CONTROL NUMBER: 53-CC-20230308161328
FACILITY NAME:IVY, KIMBERLYFACILITY NUMBER:
393620016
ADMINISTRATOR:IVY, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 475-8584
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:14CENSUS: DATE:
06/05/2023
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Licensee, Ivy, KimberlyTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
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9
 Inappropriate language in front of daycare children
INVESTIGATION FINDINGS:
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9
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13
During the course of the investigation, LPA Melnichuk conducted interviews and observations. It was alleged that the licensee uses inappropriate language in front of daycare children. Interviews did not reveal concerns about the language used around children.

Based on the information obtained throughout the course of this investigation the above allegation could not be substantiated or dismissed. LPA learned that there was conflicting evidence about the extent of licensee’s discipline and the language spoken around the children. 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: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
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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