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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103908214
Report Date: 10/15/2019
Date Signed: 10/15/2019 10:44:31 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
07/19/2019 and conducted by Evaluator Angelica Slaughter
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190719085931
FACILITY NAME:SEGOVIA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
103908214
ADMINISTRATOR:SEGOVIA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 709-9639
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:14CENSUS: 4DATE:
10/15/2019
UNANNOUNCEDTIME BEGAN:
09:30 PM
MET WITH:Guadalupe SegoviaTIME COMPLETED:
11:00 PM
ALLEGATION(S):
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Licensee denied fluids to daycare children.
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) Angelica Slaughter conducted a follow-up complaint inspection to the facility and met with Licensee, Guadalupe Segovia. The purpose of the inspection was to deliver the findings for the above complaint allegation.

During the course of the investigation, LPA conducted interviews with Licensee, staff, daycare children and parent(s) of day care children. Based on the information obtained during the investigation, there is a preponderance of the evidence to prove Licensee denied fluids to daycare children; therefore, the allegation is substantiated.

Per California Code of Regulation, Title 22, Division 12, deficiencies were cited (continued on next page).

Licensee was provided a copy of the report, appeal rights, and a LIC 9213 - NOTICE OF SITE VISIT form, which is required to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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 4
Control Number 04-CC-20190719085931
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: SEGOVIA, GUADALUPE FAMILY CHILD CARE
FACILITY NUMBER: 103908214
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2019
Section Cited
CCR
102423(a)(4)
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Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This
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Licensee stated she is going to work on changing the way she interacts with her daycare children. She is going to also watch 2 videos on the CCLD website. One video is concerning supervision of children in care and the second is concerning personal rights
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requirement was not met as evidenced by this investigation. Licensee denied fluids to daycare children. This posses an immediate risk to the health, safety and/or personal rights of children in care.
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of children in care. Licensee will communicate to LPA what she learned from the videos. POC is due by end of day on Wednesday, October 16, 2019.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
07/19/2019 and conducted by Evaluator Angelica Slaughter
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190719085931

FACILITY NAME:SEGOVIA, GUADALUPE FAMILY CHILD CAREFACILITY NUMBER:
103908214
ADMINISTRATOR:SEGOVIA, GUADALUPEFACILITY TYPE:
810
ADDRESS:14088 W. B STREETTELEPHONE:
(559) 709-9639
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:14CENSUS: 4DATE:
10/15/2019
UNANNOUNCEDTIME BEGAN:
09:30 PM
MET WITH:Guadalupe SegoviaTIME COMPLETED:
11:00 PM
ALLEGATION(S):
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Licensee hit daycare child.
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced follow up complaint inspection to the facility. LPA met with Licensee, Guadalupe Segovia. The purpose of the inspection was to deliver the findings for the above complaint allegation.

During the course of the investigation, LPA conducted interviews with Licensee, staff, day care children and parent(s) of daycare children. The interviews revealed inconsistencies in the allegation of Licensee hit daycare child.

Although the allegtion may have happened or may be valid, there is not a preponderance of the evidence to prove the allegation; therefore, the allegation is unsubstantiated.

Per California Code of Regulations, Title 22, Division 12, no deficiency is cited during today’s inspection. A Notice of Site Visit to be posted on parent board.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica SlaughterTELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4