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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197407420
Report Date: 02/16/2021
Date Signed: 02/16/2021 03:54:36 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/28/2021 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20210128092017
FACILITY NAME:MIKKLESEN-ACUNA FAMILY CHILD CAREFACILITY NUMBER:
197407420
ADMINISTRATOR:MIKKLESEN-ACUNA, RIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 968-9741
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:14CENSUS: 1DATE:
02/16/2021
UNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH: Rian Mikklesen-Acuna, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff did not keep child's information confidential.
INVESTIGATION FINDINGS:
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This report is being delivered electronically per Tele-Visits Procedure for COVID-19.
On 02/16/2021 at 2:57 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced virtual visit and met and informed Rian Mikklesen-Acuna, licensee, of the reason for the visit: Delivery of report finding against the alleged complaint. During the interview, licensee admitted that she wrote a child’s name in text message sent to other parents; thus, she did not keep child's information confidential. After conducting a virtual interview and obtaining a written declarative statement from licensee, the following conclusion has been reached: Substantiated - A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The facility was cited a Type B deficiency according to California Code of Regulations Title 22 (See LIC 9099D report for deficiency). An exit interview and a copy of this report along with Appeal Rights were explained and provided to Rian Mikklesen-Acuna, licensee.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
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 3
Control Number 30-CC-20210128092017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MIKKLESEN-ACUNA FAMILY CHILD CARE
FACILITY NUMBER: 197407420
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2021
Section Cited
CCR
102423(a)(1)
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Personal Rights
Each child receiving services from a family childcare 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
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On 10/12/20, licensee self-reported the incident that occurred on 10/12/20. On 01/26/2021, licensee self-reported the same incident. Per FAS, there was no document of any complaint submitted to the department against the above facility from 10/9/20 through 01/26/21. Licensee self-reported
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not limited to, the following: To be treated with dignity in his/her personal relationship with staff and other persons.
This requirement is not met as evidenced by licensee writing a child’s name in text message sent to other parents; thus, she did not keep child's information confidential. Based on interviews conducted and evidence (text messages) obtained, the licensee failed to ensure that a child was treated with dignity in his personal relationship with others. This poses a potential health and safety risk to children in care.

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the incident before a complaint was generated by the reporting party. Licensee created Policies and Procedures stating that “all families will be notified of all illness immediately upon receiving information without disclosing children names” on 10/12/20.

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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.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20210128092017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MIKKLESEN-ACUNA FAMILY CHILD CARE
FACILITY NUMBER: 197407420
VISIT DATE: 02/16/2021
NARRATIVE
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On 10/12/20, licensee self reported the incident that occurred on 10/12/20. On 01/26/2021, licensee self reported the same incident. Per FAS, there was no document of any complaint submitted to the department against the above facility from 10/9/20 through 01/26/21. Licensee self reported the incident before a complaint was generated by the reporting party. Licensee created Policies and Procedures stating that “all families will be notified of all illness immediately upon receiving information without disclosing children names” on 10/12/20.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3