013421853-2-19-2021-52-CC-CCHS-BYQMVB-20210302085625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 013421853
Report Date: 02/19/2021
Date Signed: 02/19/2021 11:47:35 AM

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 STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2021 and conducted by Evaluator Russell Haderer

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20210217110626

FACILITY NAME:	MONTOYA, ROBERT		FACILITY NUMBER:	013421853
ADMINISTRATOR:	MONTOYA, ROBERT		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 377-8148
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 7	DATE:	02/19/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Robert Montoya		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Personal Rights - Diaper changing on the floor

INVESTIGATION FINDINGS:

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On February 19, 2021 at approximately 9:50AM Licensing Program Analyst (LPA) Haderer met with Licensee Robert Montoya for an unannounced visit to investigate a complaint. Present today was the licensee, and fingerprint cleared helpers Bianca Mellado and Lori Bogisich and seven children in care (two 9-month olds, two 2-year olds, one 4 year old, one 7 years old and one 10 years old). LPA explained he was there to investigate an anonymous complaint and toured the facility with the licensee.

The complainant stated that no changing table was visible and licensee changes children's diapers on the floor of the facility and they are not using a mat or pad under the children.

The Licensee explained the diaper changing process and that each child has their own diapers and personal materials when change babies. Everything is thoroughly cleaned and wiped down after each change. There was a smell of cleaner when LPA arrived at the facility..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021

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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Control Number 52-CC-20210217110626

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTOYA, ROBERT	FACILITY NUMBER: 013421853
	VISIT DATE: 02/19/2021

NARRATIVE

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There are no regulations on using a changing table or a changing pad to change children's diapers. LPA witnessed the process of changing a child while he was present. Licensee used a pad and a personal towel (specific to each child) and licensee stated most of the time he uses a pad under the children while changing, while sometimes it's done on the area rug (still using the personal towel).

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, there the allegation is UNSUBSTATIANTED.

Exit interview conducted. A copy of this report was provided. Appeal rights was discussed and a copy was given.

LPA left the facility at 12:00PM

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021

LIC9099 (FAS) - (06/04)

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