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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073404172
Report Date: 12/17/2021
Date Signed: 12/17/2021 06:59:49 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
08/03/2021 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20210803155528
FACILITY NAME:VERDUZCO, LISAFACILITY NUMBER:
073404172
ADMINISTRATOR:VERDUZCO, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 234-9988
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:LISA VERDUZCOTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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LICENSE- Licensee failed to provide the parents of the daycare children with LIC 9224
INVESTIGATION FINDINGS:
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LICENSING PROGRAM ANALYST ALEXANDER MET WITH LICENSEE LISA VERDUZCO TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATION.

UPON ARRIVAL THERE ARE _ CHILDREN IN CARE ALONG WITH LICENSEE AND HUSBAND/ASSISTANT RYAN VERDUZCO. A REVIEW OF THE CHILDREN'S FILES WAS CONDUCTED DURING AN ANNUAL/REQUIRE VISIT IN OCTOBER 2021. AT THAT TIME, THERE WERE NO LIC 9224 FORMS OBSERVED IN THE FILES.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPODERANCE OF EVIDENCE STANDARD HAS BEEN MET, THEREFORE THE ABOVE ALLEGATION IS FOUND TO BE SUBSTANTIATED. California Code of Regulations, (Title 22, Division 1 & Chapter 12), are being cited on the attached LIC. 9099D.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 02-CC-20210803155528
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: VERDUZCO, LISA
FACILITY NUMBER: 073404172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2021
Section Cited
HSC
1596.8595(c)(1)
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Health and Safety Code Section 1596.8595 (c) A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b.
REQUIREMENT WAS NOT MET: LICENSEE FAILED TO PROVIDE DAY CARE PARENTS WITH THE LIC 9224 ASSOCIATED WITH THE TYPE A VIOLATION CITED 6/2021
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LICENSEE WILL PROVIDE EACH DAY CARE PARENT A COPY OF THE REPORT & CITATION. LICENSEE WILL ALSO PROVIDE THE LIC 9224 TO BE SIGNED AND PUT INTO THEIR CHILD'S FILE BY 12/20/21
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2