Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 203806650
Report Date: 02/20/2018
Date Signed 02/20/2018 01:16:57 PM


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
11/30/2017 and conducted by Evaluator Kathie Campbell
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20171130165154
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: 2DATE:
02/20/2018
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Eva UribeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee failed to provide adequate supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA's Kathie Campbell and Patricia Musso arrived at facility to conduct an unannounced complaint inspection. Met with licensee, Eva Uribe. Census was taken, and LPA discussed the allegation. The Department investigated the allegation that the licensee failed to provide adequate supervision. LPA interviewed licensee, witnesses, and children. Reviewed facility records. Although licensee made conflicting statements during this investigation, there was not sufficient information to say whether or not the licensee, or her daughter who assists her were present in the home with day care children or if the day care children were left alone with a non adult. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is 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.
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: 02/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2018
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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