073404172-12-30-2020-02-CC-MMEA-BWSVKE-20201230153013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 073404172
Report Date: 12/30/2020
Date Signed: 12/30/2020 02:05:17 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
06/11/2020 and conducted by Evaluator Tasha Hackett-Alexander

COMPLAINT CONTROL NUMBER: 02-CC-20200611152549

FACILITY NAME:	VERDUZCO, LISA		FACILITY NUMBER:	073404172
ADMINISTRATOR:	VERDUZCO, LISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 234-9988
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	14	CENSUS:	DATE:	12/30/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	LISA VERDUZCO		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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8
9

OTHER- unsafe and unsanitary conditions in home

INVESTIGATION FINDINGS:

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LICENSING PROGRAM ANALYST ALEXANDER MET WITH LICENSEE LISA VERDUZCO VIA TELE-VISIT DUE TO THE COVID-19 PANDEMIC TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATION.

ON THIS ANALYST'S LAST VISIT AN INTERVIEW WAS CONDUCTED WITH LICENSEE AND A FACILITY ROSTER WAS REQUESTED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE OF STANDARD HAS BEEN MET, THEREFORE THE ABOVE ALLEGATION IS FOUND TO BE SUBSTANTIATED. CALIFORNIA CODE OF REGULATIONS, TITLE 22, DIVISION 12 & CHAPTER 1 ARE BEING CITED ON THE ATTACHED LIC 9099D

TODAY AN EXIT INTERVIEW WAS CONDUCTED. A COPY OF THIS REPORT IS TO BE KEPT FOR 3 YEARS. A COPY OF THIS REPORT WAS ALSO EMAILED TO LICENSEE.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020

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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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
06/11/2020 and conducted by Evaluator Tasha Hackett-Alexander

COMPLAINT CONTROL NUMBER: 02-CC-20200611152549

FACILITY NAME:	VERDUZCO, LISA		FACILITY NUMBER:	073404172
ADMINISTRATOR:	VERDUZCO, LISA		FACILITY TYPE:	810
ADDRESS:	4613 REGINA COURT		TELEPHONE:	(925) 234-9988
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94509
CAPACITY:	14	CENSUS:	DATE:	12/30/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	LISA VERDUZCO		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

LACK OF SUPERVISION- Licensee slept on couch while children in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LICENSING PROGRAM ANALYST ALEXANDER MET WITH LICENSEE LISA VERDUZCO VIA TELE-VISIT DUE TO THE COVID-19 PANDEMIC TO DELIVER THE FINDINGS TO THE ABOVE COMPLAINT ALLEGATION.

ON THIS ANALYST'S LAST VISIT, AN INTERVIEW WAS CONDUCTED WITH LICENSEE AND A COPY OF THE FACILITY ROSTER WAS REQUESTED.

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.

AN EXIT INTERVIEW WAS CONDUCTED. A COPY OF THIS REPORT IS TO BE KEPT FOR 3 YEARS. A COPY OF THIS REPORT HAS ALSO BEEN EMAILED TO LICENSEE.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 02-CC-20200611152549

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: 12/30/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/12/2021 Section Cited CCR 102417(b)	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. based BASED ON THE EVIDENCE RECIEVED AND LPAs OVSERVATIONS, THE BATHROOM IS UNKEMPT AND HAS ITEMS EXPOSED THAT MAY BECOME HARMFUL TO CHILDREN IN CARE.	1 2 3 4 5 6 7	LICENSEE SHALL ENSURE THAT ALL AREAS THAT CHILDREN IN CARE OCCUPY IS FREE FROM DEBRIS/TOXINS/UNSAFE MATERIALS AT ALL TIMES. LICENSEE WILL CLEAN THE HALL BATHROOM, KITCHEN AND LIVING ROOM AND SUBMIT PROOF BY 1/12/21.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2020

LIC9099 (FAS) - (06/04)

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