Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198013326
Report Date: 12/02/2016
Date Signed 12/02/2016 03:28:45 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2016 and conducted by Evaluator Adriana Hernandez
COMPLAINT CONTROL NUMBER: 33-CC-20160725105845
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
198013326
ADMINISTRATOR:DAVIS, ELAINE & WENDELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 805-0005
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 5DATE:
12/02/2016
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Elaine DavisTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Personal Rights: Child was touched innapropriately by adult in home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Adriana Hernandez arrived at the Davis Family Child Care Home for the purpose of delivering findings on the complaint investigated by LPA and partially by Investigation Bureau (IB), it was alleging that Adult #1 touched Adult #2 inappropriately when Adult #2 was a minor. Upon arrival LPA met with Wendell Davis and then Licensee Elaine Davis and the nature of the visit was discussed.

Interviews were conducted and/or attempted with the Complainant, Parent #1, Witness, Licensee and Adult #1.

Complainant stated that Adult #2 disclosed the following:
• Adult #2 stated that Adult #1 would come into the room while Adult #2 was sleeping and…
• Adult #2 stated that Adult #1 would touch Adult #2 inappropriately.
• Adult #2 stated that Adult #2 would wake up from feeling the heavy body of Adult #1 on top of Adult #2.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Adriana HernandezTELEPHONE: 323-981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3



Control Number 33-CC-20160725105845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 198013326
VISIT DATE: 12/02/2016
NARRATIVE
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Complainant stated this incident occurred when Adult #2 was a minor and it was not reported back then because Adult #2 feared that Licensee and Parent #1 would not help Adult #2 and that Licensee could lose business if it was reported.

Complainant stated that Adult #2 also disclosed that during a family discussion, Adult #2 discovered that; Adult #1 had done the same thing to a cousin and an aunt of Adult #2. Complainant stated that Adult #2 passed away in September of 2015 thus; the Department was not able to obtain an interview with Adult #2.

Parent #1 declined to be interviewed regarding Adult #2.

Witness stated that Witness contacted Parent #1 regarding the allegation made against Adult #1. Witness stated that Parent #1’s response was that Adult #1 doesn't know what Adult #1 is doing because Adult #1 “Has like dementia or something". Witness stated that the reason it was not reported was because Adult #2 feared that Parent #1 and Licensee would then turn their back on Adult #2 and not help Adult #2.

Licensee stated the following:
· Adult #2 disclosed to Licensee that; Adult #2 did not like that Adult #1 hugged Adult #2.
· Licensee denies that Adult #2 disclosed any inappropriate touching by Adult #1 towards Adult #2.
· Licensee denies that there was a discussion in which it was discovered that Adult #1 had allegedly inappropriately touched a cousin and an aunt of Adult #2.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Adriana HernandezTELEPHONE: 323-981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2016
LIC9099 (FAS) - (06/04)
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Control Number 33-CC-20160725105845
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVIS FAMILY CHILD CARE
FACILITY NUMBER: 198013326
VISIT DATE: 12/02/2016
NARRATIVE
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Adult #1 denied knowing of any complaints of hugging Adult #2. Adult #1 described relationship with Adult #2 as normal. Adult #1 denied inappropriately touching Adult #2.

This agency has investigated the complaint alleging a personal rights violation and found 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, therefore at this time the allegations are deemed INCONCLUSIVE.

Exit interview conducted with licensee Elaine Davis. Notice of Site Visit posted. The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal Rights (LIC 9058 FAS 01/16) were explained and provided to the licensee.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Adriana HernandezTELEPHONE: 323-981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2016
LIC9099 (FAS) - (06/04)
Page: 3 of 3