Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 203806650
Report Date: 01/12/2018
Date Signed 01/18/2018 11:35:49 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2017 and conducted by Evaluator Kathie Campbell
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20171013100710
FACILITY NAME:URIBE, EVA FAMILY CHILD CAREFACILITY NUMBER:
203806650
ADMINISTRATOR:URIBE, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 664-0747
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY:14CENSUS: 6DATE:
01/12/2018
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Eva UribeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Licensee does not live in the home
Licensee is absent from the home longer than the allotted amount of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kathie Campbell arrived at facility to conduct an unannounced complaint visit to gather information to investigate the above mentioned allegations. Met with licensee, Eva Uribe who accompanied LPA during tour of facility both inside and outside. LPA discussed the allegations, and census taken. LPA interviewed the licensee during this visit. Licensee stated she is here at this home when day care children are here. She does have another home in her name but will go there on her days off or when there are no day care children. Licensee stated she doesn't live there, the day care home is where she lives. LPA interviewed witnesses, and reviewed reports and records.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 1 no deficiency are cited during today's visit.
An exit interview conducted with licensee, Eva Uribe. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
"This is an Amended document of original report created on 1/12/18".
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Kathie CampbellTELEPHONE: (559) 341-4724
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2018
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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