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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393620016
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:25:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 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
08/21/2023 and conducted by Evaluator David Nguyen
COMPLAINT CONTROL NUMBER: 53-CC-20230821155446
FACILITY NAME:IVY, KIMBERLYFACILITY NUMBER:
393620016
ADMINISTRATOR:IVY, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 475-8584
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:14CENSUS: 4DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:licensee, Kimberly IvyTIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child was inappropriately touched by another child while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Lauren Scott and David Nguyen met with Licensee, Kimberly Ivy to deliver the findings of the complaint investigation regarding the above allegation.
During the course of the investigation, LPA Melnichuk conducted interviews, and obtained information pertaining to the above allegation. It was alleged that a child (C1) was inappropriately touched by another child in care. Interviews conducted did not corroborate the allegation. LPA was unable to interview the child. No additional information was provided to support the allegation.
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.
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: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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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