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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197412996
Report Date: 07/02/2019
Date Signed: 07/02/2019 11:24:21 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2019 and conducted by Evaluator Brianna Reynoso
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20190528110738
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197412996
ADMINISTRATOR:MARTINEZ, LORETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 285-1332
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 8DATE:
07/02/2019
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Loretta MartinezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Licensee hit daycare child while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/2/2019 at 9:45 a.m., Licensing Program Analyst (LPA), Brianna Reynoso met with above facility's licensee, Loretta Martinez. LPA was at the facility to conduct a complaint investigation and deliver the findings pertaining to the allegation mentioned above.

Upon arrival, LPA verified a census of eight children in care, and also present was Staff 2.

During the course of this investigation, LPA conducted interviews, file reviews, and obtained copies of all pertinent information related to the allegation.

Based on the information obtained from interviews with children and staff, LPA was informed Child 1 had attended the day care about five years ago, however there were no disclosures indicating anyone had witnessed the licensee or any other adult having hit the child in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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 12-CC-20190528110738
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197412996
VISIT DATE: 07/02/2019
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the aforementioned allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, notice of site visit, and appeal rights were provided to licensee, Loretta Martinez.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2