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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313621167
Report Date: 08/17/2021
Date Signed: 08/17/2021 12:26:06 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2021 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20210528160741
FACILITY NAME:BORJA POLANCO, LYANNAFACILITY NUMBER:
313621167
ADMINISTRATOR:BORJA POLANCO, LYANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 865-4258
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 5DATE:
08/17/2021
UNANNOUNCEDTIME BEGAN:
12:30 AM
MET WITH:Lyanna Borja Polanco - LicenseeTIME COMPLETED:
01:00 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
An unannounced inspection is conducted today by Licensing Program Analyst Owens and Blesi. LPA's met with licensee Lyanna Borja Polanco. Present at time of inspection were Licensee, her assistant Ms. Romo and 5 day care children.

The purpose of the inspection is to close a complaint investigation that was originally opened on June 1, 2021. The complaint was investigated by the Investigations Branch (IB) . Based on the Investigations Branch (IB) investigation there was not a preponderance of evidence to support the above allegation or incident occurred therefore, this complainant is unsubstantiated.

An exit interview was conducted. Appeal rights were emailed and explained to the licensee.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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