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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700224
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:51:13 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2021 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20210803160947
FACILITY NAME:JONES PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197700224
ADMINISTRATOR:JONES, KYIAMOWAKIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 941-3706
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 1DATE:
09/29/2021
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:KYIAMOWAKI JONESTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Personal Rights: Child sustained injuries while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Lady King-Lewis conducted a subsequent complaint inspection at the facility for the purpose of delivering the findings of the above allegation. Upon arrival no one was at the facility. Later LPA was met by licensee, no children were in care. Around 3:00 pm a bus arrived with one day care child.

The investigation consisted of interviews with licensee, licensee's assistant, children in care, licensee biological children and other pertinent parties. Although there were a injury, the Department could not determine how the child sustained the scratch on face and lower neck. Based on the preponderance of the evidence, the above allegation has been deemed to be unsubstantiated at this time. If the Department obtains additional evidence to support the above allegation, the complaint will be reopened.

An exit interview was conducted with licensee’s assistant, a copy of this report was provided along with the appeal rights and Notice of Site Visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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