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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421310
Report Date: 08/07/2019
Date Signed: 08/07/2019 02:02:21 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2019 and conducted by Evaluator Dayna Collier
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20190227102527
FACILITY NAME:DE LA CRUZ-MORAN, MARIAFACILITY NUMBER:
013421310
ADMINISTRATOR:DE LA CRUZ-MORAN, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 978-0176
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY:14CENSUS: 11DATE:
08/07/2019
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maria De La Cruz-MoranTIME COMPLETED:
02:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS: Child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Dayna Collier met with licensee Maria De La Cruz-Moran for a complaint investigation to deliver the findings of an investigation. The investigation was conducted by Special Investigator Eddie Phung of the Bureau of Investigations. Present for the investigation were licensee, licensee's assistants Maria Silva and Maria Parilla as well as 11 children in care consisting of 3 infants and 8 preschoolers. During the course of the investigation, interviews were conducted. There was no evidence to support where and when the injuries occurred. Licensee denied that the injuries occurred while in care. Licensee stated that the child did sustain a small scratch caused by another child while in care.
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, the allegation is unsubstantiated.

A SITE VISIT NOTICE WAS POSTED BY LICENSEE.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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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