Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017228
Report Date: 05/02/2016
Date Signed: 05/02/2016 12:44:32 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2016 and conducted by Evaluator Timothy Fields
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20160426151303
FACILITY NAME:NICHOLAS FAMILY CHILD CAREFACILITY NUMBER:
198017228
ADMINISTRATOR:NICHOLAS, SHAMEKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 788-0855
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 9DATE:
05/02/2016
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Shameka NicholasTIME COMPLETED:
11:47 AM
ALLEGATION(S):
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Home is malodorous
INVESTIGATION FINDINGS:
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A complaint visit was conducted by LPA Timothy Fields to investigate an allegation the facility smelled of marijuana. LPA met with Licensee Shameka Nicholas who informed LPA there is no smoking of any kind allowed in the facility. Licensee states there was an incident that occurred in December of 2015 during a parent teacher meeting conducted in the facility where she had to speak to a parent about an odor of marijuana. Licensee states she explained to the individual that was not an appropriate smell to have in her facility. Licensee states she has a policy where parent are not allowed to arrive or remove a child that is visibly impaired or with an odor of any type of drug.

Licensee states there were two separate incidents that she discussed with a parent regarding odors in the home. Licensee states her spouse uses a shaving compound that has a strong odor. Licensee states a parent brought the smell to her attention because of her child's asthma. Licensee provided LPA a sample of the compound to demonstrate the odor. Licensee also states she attempted to turn on a floor heater that had not been in use causing a smell of burnt crayons.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2016
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 33-CC-20160426151303
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: NICHOLAS FAMILY CHILD CARE
FACILITY NUMBER: 198017228
VISIT DATE: 05/02/2016
NARRATIVE
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Per licensee the heater is no longer in use and the gas company has disconnected the pilot light. Licensee insists these two odors could not be confused with the smell of marijuana. During today's visit LPA did not smell marijuana and did not observe any items used for that purpose. Based on information obtained LPA has determined the complaint to be inconclusive.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2016
LIC9099 (FAS) - (06/04)
Page: 2 of 2