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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103910889
Report Date: 12/15/2021
Date Signed: 12/15/2021 10:49:50 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
11/22/2021 and conducted by Evaluator Robert Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20211122153049
FACILITY NAME:CENTENO, ERIKA FAMILY CHILD CAREFACILITY NUMBER:
103910889
ADMINISTRATOR:CENTENO, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 679-2604
CITY:COALINGASTATE: CAZIP CODE:
93210
CAPACITY:14CENSUS: 9DATE:
12/15/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Erika CentenoTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are not wearing masks.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Robert Gutierrez conducted an unannounced complaint inspection to provide findings. LPA met with Licensee, Erika Centeno also present was Staff #1. Licensee accompanied LPA during tour of facility both inside and outside. LPA discussed the allegation and took a census. During the course of the investigation, LPA interviewed staff and reviewed facility records. Based on the interviews conducted it was determined that staff were not wearing face masks while children were in care.

Based upon observations and information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview conducted with Licensee, Erika Centeno. A copy of this report and Appeal Rights were provided and discussed with Erika Centeno.
A Notice of Site Inspection Form was posted to parent's board and must remain posted for 30 days.

Continued on 9099-D.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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 04-CC-20211122153049
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: CENTENO, ERIKA FAMILY CHILD CARE
FACILITY NUMBER: 103910889
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2021
Section Cited
CCR
102423(a)(2)
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Personal Rights. 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: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee stated she and staff shall wear mask when children in care.

Cleared during todays inspection.
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This requirement is not met as evidenced by interviews which indicated that licensee and assistants were not wearing face masks indoors while caring for children. This poses a potential risk to the health, safety or personal rights of children in care.
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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: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert GutierrezTELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
LIC9099 (FAS) - (06/04)
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