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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435700368
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:16:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/23/2024 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20241023163607
FACILITY NAME:LEVIN, DEVORAHFACILITY NUMBER:
435700368
ADMINISTRATOR:LEVIN, DEVORAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 561-6013
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:14CENSUS: 10DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Devorah LevinTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Licensee does not reside in the home.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA's) Melanie Otsuji and Julia Placencia arrived to the facility unannounced to conclude investigation into the above allegation. LPAs met with Licensee, Devorah Levin. Also present during today's visit were two additional staff members and 10 children (3 infants and 7 preschoolers).

During the course of the investigation LPAs conducted inteviews, made observations and conducted record reviews. Based on this information conducted 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 allegation is UNSUBSTANTIATED.
A notice of site visit was given and must remain posted for 30 days.
Appeal Rights were given and discussed.

An exit interview was conducted with Licensee, Devorah Levin.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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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