100405182-5-7-2020-04-CC-AJUZ-BPDSH7-20200507135305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100405182
Report Date: 04/21/2020
Date Signed: 05/07/2020 09:24:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2020 and conducted by Evaluator Caroline Harris

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20200317132954

FACILITY NAME:	DERMER'S CREATIVE CARE		FACILITY NUMBER:	100405182
ADMINISTRATOR:	DERMER, ADAM		FACILITY TYPE:	850
ADDRESS:	321 W. HERNDON AVENUE		TELEPHONE:	(559) 435-2901
CITY:	PINEDALE	STATE: CA	ZIP CODE:	93650
CAPACITY:	77	CENSUS: 10	DATE:	04/21/2020
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Assistant Director, Jean Herrera		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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9

Staff did not report the incident to the authorized representative.

INVESTIGATION FINDINGS:

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On 4/21/20 Licensing Program Analyst (LPA) Caroline Harris conducted a telephone call with Assistant Director, Jean Herrera to close the above complaint investigation. Due to the COVID-19 pandemic, no one was available to conduct an in person visit. A census was taken. LPA explained the above listed allegation to the licensee. The investigation consisted of interviews with the director, assistant director, staff and children. Copies of facility records including attendance records and facility forms were also gathered.

Based upon information and interviews conducted, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
California Code of Regulations, Title 22, Division 12, Chapter 1/3, are being cited on the attached LIC 9099-D. An exit interview was conducted with Jean Herrera. A copy of this report was e-mailed to Mrs. Herrera she was asked to sign and date the report and send a copy back to the Fresno CCL office.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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 04-CC-20200317132954

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: DERMER'S CREATIVE CARE	FACILITY NUMBER: 100405182
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/27/2020 Section Cited CCR 101212(a)(C)(f)	1 2 3 4 5 6 7	Reporting Requirements. Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to: Any unusual incident that threatens the physical or emotional health or	1 2 3 4 5 6 7	The assistant director stated that she will review the reporting requirements with her staff and submit a copy of the agenda and staff sign in form to the Fresno CCL office by the due date of 4/27/20.
	8 9 10 11 12 13 14	safety of any child. The items specified in (d)(1)(A) through (H) shall also be reported to the child's authorized representative. This requirement was not met as evidenced by the licensee not reporting an incident to CCL or the authorized representative.	8 9 10 11 12 13 14
	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: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline Harris	TELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

LIC9099 (FAS) - (06/04)

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