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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409328
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:43:59 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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2024 and conducted by Evaluator Catherine Fernandes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240930154110
FACILITY NAME:COLLINS, JANELLFACILITY NUMBER:
073409328
ADMINISTRATOR:COLLINS, JANELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 436-3720
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:14CENSUS: 0DATE:
10/24/2024
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Janell Collins TIME COMPLETED:
01:51 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider is allowing an uncleared adult to reside in the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/24/24, at 1:17PM, Licensing Program Analyst (LPA) Catherine Fernandes arrived unannounced to deliver the findings to the above allegation and met with Licensee Janell Collins. There were no children in care the visit. During the investigation LPA Fernandes conducted interviews, reviewed documentation pertaining to the allegation and did a walk through of the home.

Interviews indicated conflicting information regarding the above allegation. Therefore, the allegation is unsubstantiated, 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.


Exit interview conducted with Licensee
Appeal Rights, Report, and Notice of Site visit provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024
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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