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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418793
Report Date: 01/26/2022
Date Signed: 02/02/2022 03:37:33 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
01/21/2022 and conducted by Evaluator Lisa Rios
COMPLAINT CONTROL NUMBER: 30-CC-20220121114100
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197418793
ADMINISTRATOR:PEREZ, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 384-3108
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:12CENSUS: 4DATE:
01/26/2022
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee Lilia PerezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Personal Rights
Licensee is not following proper COVID-19 mask guidance.
Licensee accepts children with signs of illness.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lisa Rios made an unannounced inspection to the Perez Family Child Care on 1/26/21 at 8:45 am for the purpose of initiating an investigation on the above allegations.. LPA Rios met with Licensee Lilia Perezand together discussed the investigation details.

Based on observation when LPA Rios arrived to the home, neither the licensee nor the children are wearing masks in the home. According to PIN 21-29-CCP the state requires masks ibe worn in the home for everyone over the age of 24 months in response to Covid-19. Also observed was a child wiping her nose on her jacket sleeve multiple times.

The Department has concluded, based on the preponderance of the evidence obtained during this investigation, that the allegation of (indicate the complaint allegation) is SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 30-CC-20220121114100
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197418793
VISIT DATE: 01/26/2022
NARRATIVE
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The following deficiency 102423 (a)(2) is cited per California Code of Regulations, TITLE 22, DIVISION 12, CHAPTER 1 Articles 1-7.

Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20220121114100
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197418793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/26/2022
Section Cited
CCR
102423(A)(2)
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102423(a)(2) Personal Rights
(a) 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. These rights include, but are not limited to, the following:
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The lciensee shall ensure that all children will start wearing masks when at the home and send pictures of the children wearing masks to LPA Rios at lisa.rios@dss.ca.gov by 2/10/22
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(2) To receive safe, healthful, and comfortable accommodations....

Based on observations, the children are not required to wear masks at the family child care home and children are not screened for signs of illness.
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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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
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