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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197413659
Report Date: 04/20/2021
Date Signed: 04/21/2021 03:52:46 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
03/30/2021 and conducted by Evaluator Brigitte Tsutaoka
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210330134710
FACILITY NAME:PENA & CAMPOS FAMILY CHILD CAREFACILITY NUMBER:
197413659
ADMINISTRATOR:PENA CAMPOS, SONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 942-6971
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: 2DATE:
04/20/2021
UNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Licensee Sonia Pena CamposTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Facility staff did not meet day care child's hygiene needs.
INVESTIGATION FINDINGS:
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On April 20, 2021, Licensing Program Analyst (LPA) Brigitte Tsutaoka contacted Licensee to deliver the findings for the above complaint allegation.

During the investigation, LPA Tsutaoka interviewed staff, parents, children, and other relevant complaint parties. Based on interviews conducted and additional information obtained, Child 1 needs additional assistance in the restroom and facility staff failed to verify child was cleaned after using restroom facilities.

Based on LPAs observations, interviews conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1, 102423 (a)(2) Personal Rights Type B violation is being cited on attached LIC9099D.

An exit interview was conducted, and a copy of this report was read and sent via email with read receipt (due to COVID-19). In addition, another copy will be certified mail to Licensee, Sonia Pena Campos.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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 2
Control Number 12-CC-20210330134710
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: PENA & CAMPOS FAMILY CHILD CARE
FACILITY NUMBER: 197413659
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2021
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights...(2)To receive safe, healthful, and comfortable accommodations. This requirement was not met as evidence by:
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Licensee will ensure the restroom hygiene of Child 1 by creating a toilet training plan and schedule with parent approval. Licensee agreed to submit a copy of the toilet training plan and toilet training schedule to the Department no later than April 30, 2021.
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Based on observation, interview, and record review: Facility staff did not ensure Child 1 was clean after using the restroom, which poses a potential health and safety risk to children in care.
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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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2