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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393621392
Report Date: 06/20/2022
Date Signed: 06/20/2022 02:26:57 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
04/21/2022 and conducted by Evaluator Christopher Jackson
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220421141622
FACILITY NAME:MOODY, DOLORISFACILITY NUMBER:
393621392
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
06/20/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Dolores MoodyTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Uncleared adult working at the day care facility
Licensee left day care children alone with an adult who was sleeping
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Lauren Scott and Christopher Jackson met with licensee Doloris Moody to deliver the findings of the complaint investigation regarding the above allegations.

During the course of the investigation, LPA Scott conducted interviews with multiple parents, children in care and obtained information pertaining to allegations. The first allegation alleged an "uncleared adult was working at the day care facility." Interviews conducted provided conflicting statements regarding the allegation. LPA learned that the licensee has a family member who will stop by the facility, but licensee states they have never been left alone to supervise children in care. Regarding he second allegation "children were left with an adult who was sleeping." Although there was evidence an adult was sleeping in the home. LPA received no corroborating evidence to support if children were present or not.

Report Continues on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
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-20220421141622
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: MOODY, DOLORIS
FACILITY NUMBER: 393621392
VISIT DATE: 06/20/2022
NARRATIVE
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Based on the information obtained throughout the course of this investigation the above allegations 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.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2