434414297-6-26-2023-07-CC-JSEA-CTPSY2-20230713141650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434414297
Report Date: 06/26/2023
Date Signed: 06/26/2023 05:09:54 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2023 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20230428141533

FACILITY NAME:	JOHNSON, CHRISTINA		FACILITY NUMBER:	434414297
ADMINISTRATOR:	JOHNSON, CHRISTINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 413-9272
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 4	DATE:	06/26/2023
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Christina Johnson		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Child was left unsupervised
Provider made inappropriate comments to child

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced complaint investigation for the above allegations. LPA met with Licensee Christina Johnson and explained the reason for inspection. Present during today's inspection were Licensee and four (4) children, whom 3 were her own children.

During the course of this investigation, LPA interviewed Licensee, children, and third party. LPA conducted observation. Based on the information obtained, the above allegations are found to be UNSUBSTANTIATED, meaning although, the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Licensee Christina Johnson. A notice of site visit has been issued and must remain posted for 30 days.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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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