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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197413031
Report Date: 05/01/2020
Date Signed: 05/08/2020 08:55:53 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2020 and conducted by Evaluator Victoria Hunt
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20200213120837
FACILITY NAME:CORONEL FAMILY CHILD CAREFACILITY NUMBER:
197413031
ADMINISTRATOR:CORONEL, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 273-1695
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 0DATE:
05/01/2020
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Victoria CoronelTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Reporting Requirements- licensee failed to notify department of the an incident
INVESTIGATION FINDINGS:
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*** On 05/07/20, This report is amended to due to address the above allegation.**** LPA Hunt contacted licensee Victoria Coronel via teleconference to deliver complaint findings for the above allegation. The investigation consisted of interviews with staff, children and other complaint relevant parties.

On 01/30/20, an incident occurred in which child#1 sustained a mark to the face. The licensee failed to notify the department of the incident timely. Based on the information obtained, the above allegation is deemed Substantiated. A finding of substantiated means that allegation is valid.

A copy of this report was read and discussed with licensee. Appeal rights were discussed and will be provided. This inspection was conducted virtually via teleconference due to COVID-19. A copy of this report will be mailed to the licensee to obtain original signatures.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
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 12-CC-20200213120837
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CORONEL FAMILY CHILD CARE
FACILITY NUMBER: 197413031
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2020
Section Cited
CCR
102416.5(a)
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Reporting Requirements
The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).This requirement was not met by evidence by: Licensee failed to report an Unusual Incident.
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Licensee agrees to submit an Unusual Incident Report by the Plan of Correction Date 05/14/20. Licensee will be provided with a copy of the regulations as it pertains to reporting requirements. Licensee will provide a declaration that she has read the regulations.
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On 01/30/20, an incident occurred in which child#1 sustained a mark to the face.
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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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2020 and conducted by Evaluator Victoria Hunt
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20200213120837

FACILITY NAME:CORONEL FAMILY CHILD CAREFACILITY NUMBER:
197413031
ADMINISTRATOR:CORONEL, VICTORIAFACILITY TYPE:
810
ADDRESS:37431 DAYBREAK STREETTELEPHONE:
(661) 273-1695
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 0DATE:
05/01/2020
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Victoria Coronel, licenseeTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Personal RIghts - Child #1 sustained an injury while in care

Personal Rights - Staff left day-care child #1 in a soiled diaper for a long period of time.
INVESTIGATION FINDINGS:
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*** This report is being amended on 05/07/20 allegation was changed from substantiated to unsubstantiated due to the evidence *** LPA Hunt contacted licensee Victoria Coronel via teleconference to deliver complaint findings for the above allegations. This investigation consisted of interviews with children, staff and other relevant pertinent parties. The investigation revealed the following: On 01/30/2020, child # 1 was running with a pillow, stepped on the pillowcase which resulted in child #1 bumping his face on to the sliding glass door. At the time of the incident the licensee was not present in the home and the licensee's assistant was supervising three day-care children including child #1. The licensee's assistant intervened by running after child #1, however, her attempts were unsuccessful as she was unable to reach child #1 in a timely manner. Although, child #1 sustained a small red mark to the face, the incident was a result of an accident. Concerning the allegation of child #1 had soiled diaper for a long period of time, statements obtained were inconsistent. Based on the evidence obtained, the above allegations are deemed to be unsubstantiated. A copy of this report was read and discussed with licensee. Appeal rights were discussed and will be provided. Due to COVID19 this report will be mailed to the licensee to obtain original signatures.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3