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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 543910105
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:20:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2024 and conducted by Evaluator Christopher Burnias
PUBLIC
COMPLAINT CONTROL NUMBER: 57-CC-20240620112928
FACILITY NAME:DIAZ, CLEMENTINA FAMILY CHILD CAREFACILITY NUMBER:
543910105
ADMINISTRATOR:DIAZ, CLEMENTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 232-4255
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:14CENSUS: 7DATE:
09/12/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Clementina DiazTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee did not notify authorized representative of incident
INVESTIGATION FINDINGS:
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On 09/12/2024, An unannounced complaint inspection was conducted by Licensing Program Analyst (LPA), Christopher Burnias and Licensing Program Manager (LPM) Luisa Gavoutian. LPA met with Licensee Clementina Diaz. LPAs toured the facility and census was taken. The purpose of today's inspection is to deliver findings for the above allegation. During the course of the investigation, LPA interviewed staff, parents, children, reviewed and obtained facility records, and conducted observation of the facility.

Based on the investigation conducted through interviews, facility observations, and photo observations, LPA determined that although the child experienced minor bruising from an incident, it could not be proven that the bruises were a direct result of an injury obtained at the facility. Interviews conducted with all parties were inconsistent in specifying the exact location of where the child obtained the bruises.
**Continued on LIC 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Christopher Burnias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
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 4
Control Number 57-CC-20240620112928
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DIAZ, CLEMENTINA FAMILY CHILD CARE
FACILITY NUMBER: 543910105
VISIT DATE: 09/12/2024
NARRATIVE
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The investigation revealed through interviews, LPA’s observations, and review of records, that although the above allegations may have happened or are valid, there is not a preponderance of evidence at this time to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is cited.

Exit interview conducted with Licensee Clementina Diaz.
SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Christopher Burnias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4