192004922-7-5-2022-54-CC-VCOK-CG8LTJ-20220711090226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 192004922
Report Date: 07/05/2022
Date Signed: 07/05/2022 03:53:45 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2022 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220405155607

FACILITY NAME:	GARCIA FAMILY CHILD CARE		FACILITY NUMBER:	192004922
ADMINISTRATOR:	GARCIA, EVELIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 215-3559
CITY:	HAWAIIAN GARDENS	STATE: CA	ZIP CODE:	90716
CAPACITY:	14	CENSUS: 8	DATE:	07/05/2022
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Evelia Garcia, Licensee		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Day care child sustained unexplained injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Alicia Mooberry and Austin Estrada conducted an unannounced complaint inspection for the purpose of delivering the finding for the above allegation. At 1:20 LPAs arrived at the facility and met with Daisy Garcia, Assistant. Licensee, Evelia Garcia, arrived at 1:35pm. A tour of the facility was provided.
During the investigation, LPA Mooberry conducted interviews, reviewed records and photos, and made observations regarding the above allegation.

The complaint alleges that day care child sustained unexplained injury while in care. Licensee and staff interviews confirmed that Child #1 fell and sustained injury to the head after child slipped on sandy cement floor.
The allegation made has been supprted by evidence obtained, including evidence of physical injury. There is a preponderance of evidence to substantiate this allegation.
----Continued on LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

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 54-CC-20220405155607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 192004922
	VISIT DATE: 07/05/2022

NARRATIVE

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Licensee Evelia Garcia was informed in Spanish that the complaint regarding personal rights was substantiated.

The following is being cited in accordance to Title 22 of the California Code of Regulations. See attached 9099-D for documentation of deficiencies.
A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.LIC9224 Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

The LIC 9213- Notice of Site Visit was posted during this visit. Notice of Site Visit must be posted for 30 days. Failure to do so will result in a $100 Civil Penalty.

Exit interview was conducted with Licensee Evelia Garcia, appeal rights and procedures were explained.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20220405155607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GARCIA FAMILY CHILD CARE	FACILITY NUMBER: 192004922
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/05/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/06/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee...These rights include: To receive safe, healthful, and comfortable accommodations This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee removed the sand table and placed it on the grassy area. Per licensee, the cement area will be maintained clean and clear and a space for toddler and infants will be created on the grass area - declaration provided. Licensee will provide proof of correction by phote to LPA via email by POC due date 7/6/22
	8 9 10 11 12 13 14	Licensee and staff interviews confirmed that Child #1 fell and sustained injury to the head after Staff let go of child and child slipped on sandy cement floor. This poses an immediate risk to the health and saferty of children in care.	8 9 10 11 12 13 14
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	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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022

LIC9099 (FAS) - (06/04)

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