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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 192006954
Report Date: 02/19/2021
Date Signed: 02/19/2021 04:58:35 PM



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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2020 and conducted by Evaluator Roxana Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201207104243
FACILITY NAME:BUSTAMANTE FAMILY CHILD CAREFACILITY NUMBER:
192006954
ADMINISTRATOR:BUSTAMANTE, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 448-8406
CITY:SOUTH EL MONTESTATE: CAZIP CODE:
91733
CAPACITY:14CENSUS: 3DATE:
02/19/2021
ANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Martha BustamanteTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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- Children sustained injuries while in care
- Licensee did not report injuries to parents
INVESTIGATION FINDINGS:
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An announced tele-inspection was conducted by Licensing Program Analyst (LPA) Roxana Lopez on 2/19/2021, via zoom due to COVID-19 and precautionary measures. The purpose of this tele- inspection is to provide amended finding of the complaint investigation which was received on 12/7/2020 and amended on 2/1/2021 for further investigation. The tele-inspection was conducted with Licensee, Martha Bustamante to whom the purpose of the inspection was announced. A tour of the home was provided and census was taken.

Throughout the course of the investigation, interviews were conducted with staff, children and parents. LPA also reviewed and obtained copies of children’s rosters, childcare contract, incident reports, pictures and holiday schedule from the licensee. Additionally, LPA Lopez reviewed doctor report provided by the complainant.

Allegation:
Children sustained injuries while in care

An interview was conducted with the complainant and two witnesses who drop off and/or pick up C1 at the
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Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
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 5
Control Number 33-CC-20201207104243
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER: 192006954
VISIT DATE: 02/19/2021
NARRATIVE
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day care. Per initial complaint report, it was reported that (C1) sustained a scratch cornea on December 2020 and a bump to the forehead on June 2020. It was also alleged that a second sibling sustained a scratch behind the neck (exact date unknown).

In regards to injury # 1 scratched cornea on or about December 2020- Interviews were conducted with complainants, witnesses, victim and staff. According to complainant, C1 disclosed that an infant at the day care had poked C1 in the eye. During an interview, a statement was made by C1 that child’s eye hurt, however no other details were provided. Witness interviewed provided a statement that child’s eye was observed to be injured after child was taken to the day care.

LPA conducted interviews with staff 1 and 2. Both staff stated that they did not see the incident happen as alleged. According to staff, C1 did communicate that his/her eye hurt. Staff indicated that there was a short transition time, after having a meal, where both C1 and infant were last to transition to an adjacent room. Staff 1, stated that there is the possibility that subject of investigation bent down close to the infant, who was sitting on a feeding chair close to the ground, and subsequently got poked in the eye. However, staff also stated that, prior to getting a confirmed diagnosis, child was thought to have developed a red and watery eye due to a cold which, according to licensee, C1 was getting over.

Interviews conducted found that parent was contacted by licensee who advised that child needed to be picked up to seek medical advise. LPA conducted other interviews with parents and children. Parent’s statements did not express concerns with supervision and were satisfied with the level of care provided. Children’s statements corroborate that they do play with infant but deny seeing infant poke child 1. Although it is evident that C1 eye was indeed injured while in care, there is no evidence to support that the injury was due to neglect or lack of supervision on behalf of the licensee or that infant had known aggressive behaviors. LPA is unable to ascertain if licensee could have taken other measures to prevent child from getting injured.

In regards to injury # 2 head bump on or about June 2020- LPA conducted interviews with complainants and staff. Witnesses were also interviewed and pictures were reviewed as well. Complainant stated that C1 had one bump on the forehead upon drop off and two bumps upon pick up. Complainant stated that child 1’s brother (Child 2) who also attended daycare, disclosed that C1 fell off a bike which caused child to develop a bump on head. LPA was unable to verify statement made or obtain further information as Child 2 was not interviewed per parent’s request. Witnesses, who drop off and/or pick up C1, were interviewed ------------------------------------------------------------ Pg.2 of 5-----------------------------------------------------------------------

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20201207104243
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER: 192006954
VISIT DATE: 02/19/2021
NARRATIVE
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One witness recalls C1 having one bruise, while a second witness recalls observing two bumps. A picture taken a day earlier of child’s head appears to show one legible bump/bruise, however, due to the quality and angle of the picture taken, LPA was unable to ascertain that no other bruise or bump was sustained.

LPA conducted interview with staff 1 who stated that she observed two bumps on child 1’s forehead. Staff 1 denies that child sustained bruises while in care. According to staff, she moved C1 hair to the side while playing outside and noticed two bumps. Staff states that C1 was asked about the bumps on the head and that C1 reported to have been jumping at home and subsequently hit the forehead. Upon departure staff states that she communicated with parent about both bumps observed. According to staff, parent of Child 1 acknowledged one bump but denied child sustaining a second bump at home, adding that C1 must have hit her head while at the day care. Parent, on the other hand, stated that he questioned the bruise and agreed to follow up. Per staff 1, parent came back the next day confirming that C1 only had one bump and child’s older brother mentioning her falling off a bike. Staff 1 denies that C1 fell while under her care, adding that children were being supervised and that C1 never cried or complained about falling off a bike and getting hurt. It is unknown if there were other possible witnesses who may have observed the alleged incident as Child 2 was not interviewed. An incident report was provided weeks later at the request of the parent. However, incident report provided does not admit to child getting hurt at the day care. Due to conflicting statements and limited information provided, LPA was not able to ascertain that a second bump/bruise happened while at the day care or if licensee was negligent in providing supervision.

In regards to injury # 3- Scratch on the neck (date unknown)- LPA conducted interviews with complainant and staff. Per complainant’s request victim (Child 2) was not interviewed. Complainant stated that C2 had obtained a scratch under the care of the provider over a year ago. Per complainant, a scratch was observed on the neck of Child 2 which prompted complainant to contact licensee. The following day, complainant showed Licensee the scratch. Per complainant, licensee walked parent over to the sink where she explained how Child 2 had received a scratch to the neck.

During the initial investigation licensee denied that C2 had obtained a scratch while under her care. However, during a second interview, licensee recalled the incident in detail. According to licensee, day care children use an outdoor sink to wash hands. Licensee states that while using the sink, C 2 crouched under the sink and upon standing back up, C2 scratched/rubbed against the plastic sink which caused a scratch on the back of the neck. There are conflicting statements as to the degree of the injury.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 33-CC-20201207104243
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER: 192006954
VISIT DATE: 02/19/2021
NARRATIVE
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No pictures were available for LPA to review. It is uncertain if licensee could have taken measures to prevent the incident from occurring.

This agency has investigated the complaint alleging child 1 and child 2 sustained injuries while in care. Based upon the evidence as presented above, the allegation has been determined to be Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to support that the injuries that occurred happened due to intentional neglect or lack of supervision. Licensee has covered the sink with material as a preventive measure to ensure that no other children are scratched while using the outdoor sink.

Allegation:

Licensee did not report injuries to parents

An interview was conducted with the complainant to obtain further details regarding the allegations made. Per initial complainant report, parents were not notified of injuries occurring to their children while at the day care.

In regards to injury # 1- scratched cornea: LPA conducted interviews with complainants, staff 1 and 2. According to complainants and licensee, there was communication regarding child’s injury to the eye. According to staff, child was complaining about a runny nose and a watery eye. Staff states, that parent(s) were contacted on more than one occasion to inform parents of child’s condition. Parent, stated that he was indeed contacted, however, denies being fully informed of the severity of the child’s injury to the eye. Per staff , it was suggested to parent that child be taken to a doctor regarding an observed watery eye and runny nose. After seeing a doctor, parents inform staff 1 that child had a scratched cornea. Both staff 1 and 2 stated that they were not able to give the parents an incident report as they were not aware of the diagnosis upon pick up. Child 1 was pulled out of the family daycare and therefore licensee stated that an incident report was not given to parents. Licensee provided LPA with copies of the report that was never given to parents. The information gathered found that communication did occur between parents and staff.

In regards to injury # 2- head bump: LPA conducted interviews with complainants and staff 1. Licensee indicated that she informed parent about two head bumps observed at the day care. Although both parent and licensee acknowledge to having a conversation regarding a second bump on child’s head, there are conflicting statements as to if/when the second bump was received at the day care. ------------------------------------------------------ Pg.4 of 5 -----------------------------------------------------------------------------

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 33-CC-20201207104243
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BUSTAMANTE FAMILY CHILD CARE
FACILITY NUMBER: 192006954
VISIT DATE: 02/19/2021
NARRATIVE
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It was verified by both parent and licensee that an incident report was provided at the parent’s request. However, incident provided does not acknowledge that a second bruise occurred as licensee denies that a second bump happened at the day care. Licensee and complainant both provided LPA with copies of the incident reports.

The investigation found that an incident report was not generated and provided to parent as staff denies that child’s bumps happened a the day care

In regards to injury # 3 not being reported- scratch: LPA conducted interviews with complainants and staff 1. Per complainant, licensee did not inform parents that child # 2 obtained a scratch to the neck while in care until parent brought the issue up to licensee’s attention. Per complainants, the day after the injury licensee showed them where the incident happened and indicated that ice had to be applied to the scratch.

Initially licensee denied that child 2 had received a scratch on his neck. However, during a second interview, licensee recalled informing parents of the scratch upon pick up. LPA found that there were conflicting statements pertaining to reporting requirements. According to licensee she advised parent upon pick up that child 2 received a scratch, however, complainant denies being advised of the incident until parent made the inquiry. Based on the information gathered, LPA is unable to ascertain if licensee did or did not advise parent of the injury to the neck that child 2 sustained.

This agency has investigated the complaint alleging licensee did not report injuries. Based upon the evidence as presented above, the allegation is being deemed Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged allegation did or did not happened.

An exit interview via zoom was conducted with Licensee, Martha Bustamante and a copy of this report was signed by LPA Lopez. This report along with the appeal rights will be sent via email to Licensee, Martha Bustamante who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5