<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364818370
Report Date: 01/03/2022
Date Signed: 01/03/2022 12:20:03 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2021 and conducted by Evaluator Donna Maddox
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20211008115255
FACILITY NAME:MEDINA FAMILY CHILD CAREFACILITY NUMBER:
364818370
ADMINISTRATOR:MEDINA, SONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 887-7576
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:14CENSUS: 2DATE:
01/03/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sonia Medina TIME COMPLETED:
12:43 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not meeting the 80% daily at the facility

Licensee left day care child in soiled diaper for extended period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Maddox met with Licensee for the purpose of finalizing the above complaint allegations. Present during this inspection were 2 children and Licensee. LPA conducted interviews with children, parents, assistant, and complainant before concluding this investigation.

Based on the information provided, the above allegations are Unsubstantiated due to the lack of evidence or witnesses to substantiate allegations. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegations occurred. At this time LPA unable to make a determination that any violation(s) occurred.
An exit interview was conducted and a copy of this report was read and provided to the Licensee, Sonia Medina along with the the Notice of Site Visit was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
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 1