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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409288
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:46:30 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/04/2023 and conducted by Evaluator Michelle Sutton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230404112049
FACILITY NAME:MODICUE, TIAIRAFACILITY NUMBER:
073409288
ADMINISTRATOR:MODICUE, TIAIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 436-2427
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 0DATE:
06/15/2023
ANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Tiaira ModicueTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Care is not being provided in the Licensee’s home.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/15/23 at 1:20PM Licensing Program Analyst (LPA) Michelle Sutton conducted an announced Complaint Investigation and met with Tiaira Modicue. The LPA reviewed records, and conducted interviews. Complaint allegation is that Care is not being provided in the Licensee’s home. Based on LPA's observations, interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED. 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. No Deficiencies have been cited for the allegation.

Exit interview conducted and report was reviewed with the licensee Tiaira Modicue.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
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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