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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197416362
Report Date: 05/07/2019
Date Signed: 05/07/2019 05:19:50 PM



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
04/30/2019 and conducted by Evaluator Jillinda Chandler
COMPLAINT CONTROL NUMBER: 30-CC-20190430153805
FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197416362
ADMINISTRATOR:MENDOZA, ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 387-6751
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 10DATE:
05/07/2019
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Personal Rights - Licensee failed to properly assess injury and notify parent/guardian in a timely manner
INVESTIGATION FINDINGS:
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On 5/7/2019 Licensing Program Analyst (LPA) Chandler made an unannounced visit to the Mendoza family day care for the purpose of conducting a case-management investigation, during the course of the investigation it was found that the licensee failed to properly assess injuries and notify parent/guardian in a timely manner.

During todays investigation LPA reviewed files and conducted interviews.

Based on the above it was found that the above allegation was sustantiated meaning that the allegation is valid because the preponderance of the evidence standard has been met.

Licensee was issued an type A violation

(REPORT CONTINUED ON PAGE 2)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
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 4
Control Number 30-CC-20190430153805
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: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197416362
VISIT DATE: 05/07/2019
NARRATIVE
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The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If facility was cited type A violations or complaint is found to be substantiated or unsubstantiated, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Licensee must inform the parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC-9224 Acknowledgement of Receipt of Licensing Reports.

An exit interview was conducted, a copy of this report was provided along with the appeal rights.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 30-CC-20190430153805
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: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 197416362
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2019
Section Cited
CCR
102423(a)(2)
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102423a) Each child receiving services from a family child care 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... :(2)To receive safe, healthful, accommodations,furnishings, and
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Licensee was counseled on reporting requirements;specifically injuries that require medical attention and are to be reported to parent/gauardian immediately. Licensee shall notify all parent of licensing report via LIC, 9224 (provided). Forms shall be completed by the next business day and a copy retained
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 and comfortable equipment.This standard was not met as evidence:On four separate occassions child sustained serious reportable injuries and the parent was not immediately notified in a timely manner. This is an immediate risk to the health and safety of the child. A type A citation was issued.
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in each childs file. Parents shall also be provided a copy of todays report. Notice of site visit posting is to remain in a common area for parent viewing for 30 days.
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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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
04/30/2019 and conducted by Evaluator Jillinda Chandler
COMPLAINT CONTROL NUMBER: 30-CC-20190430153805

FACILITY NAME:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
197416362
ADMINISTRATOR:MENDOZA, ELENAFACILITY TYPE:
810
ADDRESS:11523 S. TRURO AVENUETELEPHONE:
(310) 387-6751
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 10DATE:
05/07/2019
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Neglect/ Lack of supervision - lack of supervision resulting in a child biting another child.
INVESTIGATION FINDINGS:
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On 5/7/2019 Licensing Program Analyst (LPA) Chandler made an unannounced visit to the Mendoza family day care for the purpose of conducting a case-management investigation into allegation of Neglect/ Lack of supervision

During todays interviews were conducted and files were reviewed.

Based on the above observations it was found that the allegations were unsubstantiated, meaning that although the allegation could have happened or could (possibly) be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.”
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4