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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015700235
Report Date: 10/28/2022
Date Signed: 10/28/2022 12:36:00 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 STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Simerjit Kaur
COMPLAINT CONTROL NUMBER: 52-CC-20220902171104
FACILITY NAME:KANNAN,VARSHINIFACILITY NUMBER:
015700235
ADMINISTRATOR:KANNAN, VARSHINIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(952) 686-4090
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:14CENSUS: 10DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Varshini KannanTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights: Staff handled child in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kaur arrived to the facility unannounced to conduct an investigation into the above allegation. LPA met with Licensee Varshini Kannan. Present during today's visit were 10 preschool aged children and 3 staff members.
During the course of the investigation, LPA conducted interviews and record review. Based on interviews conducted and record review, it cannot be proven or disproven that staff handled child in a rough manner. 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 at this time.

Exit interview conducted. Appeal Rights provided. Notice of site visit issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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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