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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 543908775
Report Date: 07/11/2022
Date Signed: 07/11/2022 09:04:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 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
05/09/2022 and conducted by Evaluator Theresa Marquez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220509145932
FACILITY NAME:JOHNSON, KYMBERLY FAMILY CHILD CAREFACILITY NUMBER:
543908775
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:0CENSUS: 0DATE:
07/11/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
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8
9
Licensee does not have control of property.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/11/2022, Licensing Program Analyst (LPA) Theresa Marquez provided complaint findings regarding the above allegation to Licensee Kymberly Johnson.

LPA Marquez was unable to obtain evidence to confirm an eviction notice was served and/or is in process for this facility.

Although the allegtion may have happened or may be valid, there is not a preponderance of evidence to prove licensee does not have control of property; therefore, the allegation is unsubstantiated.

Per California Code of Regulations, Title 22, Division 12, no deficiency is cited today.
A copy of Licensee's Appeal Rights and a copy of this report was provided to licensee by e-mail and US mail.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Theresa Marquez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
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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