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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 06:50:30 PM

Substantiated


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
05/10/2022 and conducted by Evaluator Theresa Marquez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220510120759
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:
03:00 PM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Conduct of adults in the home poses a risk to children in care.
INVESTIGATION FINDINGS:
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On 7/11/2022, Licensing Program Analyst (LPA) Theresa Marquez provided complaint findings regarding the above allegation to Licensee Kymberly Johnson.

On 5/19/2022, licensee and her spouse admitted to being under the influence of drugs while having children in care. These statements were confirmed by positive drug test results of both licensee and her spouse.
Based on interviews and pertinent documents obtained during the investigation, there is a preponderance of the evidence to prove adults in the home pose a risk to children in care, therefore, the allegation is substantiated.

Per California Code of Regulation Title 22, Division 12, Chapter 1, the following deficiency was cited; Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. (continued on LIC9099-D).
A copy of Licensee's Appeal Rights and a copy of this report was provided to licensee by e-mail and US mail.
Substantiated
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)
Page: 1 of 2
Control Number 04-CC-20220510120759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO SOUTH CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: JOHNSON, KYMBERLY FAMILY CHILD CARE
FACILITY NUMBER: 543908775
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2022
Section Cited
HSC
1596.885(c)
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CONDUCT INIMICAL- Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. This requirement was not met as evidenced by licensee and her spouse admitted to being under the influence of drugs while having children in care on 5/19/2022.
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Licensee surrendered her Family Child Care license on 5/18/2022. Licensee and her spouse agreed to no longer provide care for children until they have completed the Alcohol and Other Drug (AOD) services and have proven to actively remain sober.
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These statements were confirmed by positive drug test results of both licensee and her spouse.
This poses an immediate risk to the health, safety, and personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC9099 (FAS) - (06/04)
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