Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198012439
Report Date: 06/26/2018
Date Signed 06/26/2018 01:21:05 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2018 and conducted by Evaluator Joanne Alcala
COMPLAINT CONTROL NUMBER: 12-CC-20180501083905
FACILITY NAME:KIDZHAVENFACILITY NUMBER:
198012439
ADMINISTRATOR:CHAMPA S. PERERAFACILITY TYPE:
850
ADDRESS:9052 & 9052 1/2 SUNLAND BLVD.TELEPHONE:
(818) 767-2623
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:33CENSUS: 15DATE:
06/26/2018
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Champa PereraTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Personal Rights-Staff hit child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joanne Alcala arrived at the license facility for the purpose of delivering an investigation finding for the aforementioned allegation. The investigation consisted of interviewing others, reviewing records and other corroborative information. Based on the information provided it cannot be determined that the staff hit children therefore the complaint investigation is unsubstantiated . Based on the information it is determined that there is not a preponderance of evidence to prove that the alleged violations occurred.
Unsubstantiated – A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
A copy of this report and a notice of site visit were provided.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
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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