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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153910756
Report Date: 03/16/2021
Date Signed: 03/16/2021 11:15:36 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
12/09/2020 and conducted by Evaluator Rene Mancinas
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20201209155358
FACILITY NAME:GARCIA, MIGUEL & NORMA FAMILY CHILD CAREFACILITY NUMBER:
153910756
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
03/16/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Norma GarciaTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Questionable serious injury.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/16/2021 Licensing Program Analysts (LPAs) Rene Mancinas JR and Daniel Alvarez conducted an unannounced inspection to provide finding regarding the above allegation. LPAs met with Licensee, Norma Garcia. LPA Mancinas provided translation in Spanish. LPA explained and discussed the above allegation and finding with licensee.

Community Care Licensing Division-Investigations Branch Investigator Maria Barragan conducted the investigation which included review of records and documentation, as well as interviews with licensee, reporting party, parents of children in care, and medical profressionals associated to this case. Investigation conducted by Investigator Barragan revealed that although child #1 suffered a serious injury, the injury could not be attributed to occuring at the facility. Therefore, although the above allegation may have happened and/or is valid, the allegation is unsubstantiated.

Per California Code of Regulations Title 22 Division Chapter 3 no deficiencies are being cited. Notice of Site Inspection to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
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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