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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073404172
Report Date: 06/03/2021
Date Signed: 06/03/2021 05:38:24 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
03/29/2021 and conducted by Evaluator Tasha Hackett-Alexander
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210329170240
FACILITY NAME:VERDUZCO, LISAFACILITY NUMBER:
073404172
ADMINISTRATOR:VERDUZCO, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 234-9988
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 3DATE:
06/03/2021
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:LISA VERDUZCOTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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PERSONAL RIGHTS- ADULT IN HOME SPOKE TO DAY-CARE CHILDREN IN AN INAPPROPRIATE MANNER
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 3 CHILDREN IN CARE ALONG WITH LICENSEE. DURING THIS ANALYST LAST VISIT, AN INTERVIEW WAS CONDUCTED AND DOCUMENTS WERE REQUESTED.

BASED ON LPAs OBSERVATIONS AND INTERVIEWS WHICH WERE CONDUCTED AND RECORD REVIEWS, THE PREPONDERANCE OF EVIDENCE 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.

PLEASE SEE ATTACHED 9099-D FOR CITATION
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: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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 02-CC-20210329170240
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: 06/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2021
Section Cited
CCR
102432(a)(1)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
(1) To be treated with dignity in his/her personal relationship with staff and other persons.

THIS REQUIREMENT HAS NOT BEEN MET AS EVIDENCED BY: AN ADULT IN THE HOME SPOKE TO DAY CARE CHILDREN IN AN INAPPROPRIATE MANNER. THIS POSES POTENTITAL HARM TO CHILDREN IN CARE
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LICENSEE WILL ENSURE THAT ALL ADULTS/STAFF IN THE HOME TREAT CHILDREN IN CARE WITH DIGNITY AND RESPECT AT ALL TIMES AND WILL NOT SPEAK TO CHILDREN IN AN INAPPROPRIATE MANNER.
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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: 06/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC9099 (FAS) - (06/04)
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