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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015701169
Report Date: 10/09/2024
Date Signed: 10/09/2024 09:55:02 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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
09/26/2024 and conducted by Evaluator Julia Placencia
COMPLAINT CONTROL NUMBER: 52-CC-20240926093704
FACILITY NAME:CAMPOS GUZMAN, DAISYFACILITY NUMBER:
015701169
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Daisy Campos GuzmanTIME COMPLETED:
10:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Daycare child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 9, 2024 at 9:25am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to complete the complaint investigation regarding the allegation above. LPA met with licensee Daisy Campos Guzman. Present were one infant and the licensee’s 2 year old daughter.

During the course of the investigation LPA made observations, conducted interviews and reviewed documents. There is not enough evidence to prove or disprove the allegation that a day care child sustained unexplained injuries while in care. Licensee denies this allegation. Reporting party did not provide proof that C1’s injuries happened at the day care.
.
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. Exit interview conducted with licensee Daisy Campos Guzman. A notice of site visit was provided and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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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