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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197410750
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:02:24 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2022 and conducted by Evaluator Lisa Clayton
COMPLAINT CONTROL NUMBER: 30-CC-20220715132832
FACILITY NAME:HOLLAND FAMILY CHILD CAREFACILITY NUMBER:
197410750
ADMINISTRATOR:HOLLAND, MONA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 359-8384
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY:12CENSUS: 1DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:MONA HOLLAND, LICENSEETIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
CRIMINAL RECORD CLEARANCE
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/12/2022, LPA Clayton conducted an un-announced visit to deliver the findings on the above allegations. LPA was greeted by Licensee Mona Holland. LPA toured the facility for Health & Safety inspection. LPA Clayton observed 1 child in care, being supervised and cared for appropriately.

During the investigation LPA Clayton visited the home on 2 occasions and conducted interviews with the Licensee, children in care, parents/authorized representatives, licensees assistant and the Reporting Party.
Based on LPAs interviews and record review(s), the above allegation(s) are found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

Exit interview conducted and report was reviewed with Licensee Mona Holland. A notice of site visit was given and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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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