065406388-2-3-2020-13-CC-MAVS-BLKPZT-20200207104603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 065406388
Report Date: 02/03/2020
Date Signed: 02/03/2020 10:30:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2019 and conducted by Evaluator Elvira Sierra

PUBLIC

COMPLAINT CONTROL NUMBER: 13-CC-20190820154144

FACILITY NAME:	HERRERA, TERESA FAMILY CHILD CARE HOME		FACILITY NUMBER:	065406388
ADMINISTRATOR:	HERRERA, TERESA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 476-3061
CITY:	ARBUCKLE	STATE: CA	ZIP CODE:	95912
CAPACITY:	14	CENSUS: 5	DATE:	02/03/2020
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Teresa Herrera		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Personal Rights-Licensee caused injury to an infant in care

INVESTIGATION FINDINGS:

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A follow-up complaint investigation visit was conducted by Licensing Program Analyst (LPA) Elvira Sierra for the purpose of delivering findings of an investigation completed by Laura Carter-Cook, Special Investigator for the Department of Social Services, Investigations Bureau (IB). An investigation was conducted by Investigator Carter-Cook regarding allegations that the licensee caused an injury to a care; Specifically, that an infant Child (C-1) under 2 years old had received a spiral fracture of the right femur. Present in the facility was Licensee, Licensee's husband and daughter and 5 children (1 infant, 4 preschool).
LPA met with the Licensee, Teresa Herrera to deliver findings. The Licensee, Teresa Herrera denied the allegation to Investigator Carter-Cook on 12/04/2019 at approximately 11:00 AM. The Licensee denied the allegation and stated in summary that C-1 displayed signs of discomfort while in care on 08/19/19 but denied causing injury to the child or having knowledge of the injury.
Interviews were conducted with the child’s parents on 11/25/19 and 12/2/19. The child’s parents denied the injury occurring under their supervision and before this event.

Report continued on subsuquent page 9099C---------

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) -89-5984
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

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 13-CC-20190820154144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HERRERA, TERESA FAMILY CHILD CARE HOME	FACILITY NUMBER: 065406388
	VISIT DATE: 02/03/2020

NARRATIVE

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IB Investigator Carter-Cook conducted an investigation to also include interviews with 5 witnesses, 1 facility staff, 3 parents of children in care and 3 daycare children who did not corroborate the allegation. The following documentation was obtained and evaluated during the investigation; medical report, police report, photos, facility roster and facility diaper changing log.

Based on available information at this time, 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. This report was reviewed and discussed with the licensee. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today’s visit.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) -89-5984
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020

LIC9099 (FAS) - (06/04)

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