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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313623552
Report Date: 09/13/2022
Date Signed: 09/13/2022 11:28:27 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/07/2022 and conducted by Evaluator Lea Habtom
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20220907142829

FACILITY NAME:FARFAN, LORINDAFACILITY NUMBER:
313623552
ADMINISTRATOR:FARFAN, LORINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 823-7311
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:14CENSUS: 5DATE:
09/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lorinda FarfanTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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9
Licensee is forcing day care child to put chew toy in mouth
INVESTIGATION FINDINGS:
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13
Licensee is forcing day care child to put chew toy in mouth

During the investigation, LPA Habtom toured the facility, conducted observation, and interviewed those pertinent to the investigation. It was alleged that the licensee forced day care children to put chew toy in their mouth. From interviews, LPA L. Habtom was unable to gather corroborating information to validate that the licensee is forcing day care children to put chew toy in their mouth therefore the allegation is found to be UNSUBSTANTIATED. Although it may or may have not happened, there is not a preponderance of evidence to prove that the alleged violations occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022
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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