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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494080
Report Date: 07/07/2021
Date Signed: 07/19/2021 08:47:11 AM



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
04/19/2021 and conducted by Evaluator Laticia S Thompson
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210419160305
FACILITY NAME:AMADOR FAMILY CHILD CAREFACILITY NUMBER:
197494080
ADMINISTRATOR:AMADOR, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 701-6687
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 6DATE:
07/07/2021
UNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Jennifer AmadorTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Personal Rights- A child in care was not provide a safe and comfortable environment
Personal Rights- Adult in home handled a child in care roughly
INVESTIGATION FINDINGS:
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On at 07/07/2021 at 11:11am Licensing Program Analyst (LPA) Laticia Thompson conducted an unannouced vist to Amador Family Child Care Home. Upon arrival LPA was greeted at the front door by licensee assistant, Lisa Hughes whom is currently associated to the facility. Upon arrival Licensee Jennifer Amador was not within the facility. LPA advised assistant the reason for the visit today. Lisa contacted licensse by phone and informed her that LPA requested her presence at the facility. LPA observed one Adult, Lisa Hughes, 2 infants, one smaill child in the living room area, 2 infants napping in cribs in the middle room and 1 small child napping in the bedroom located next to the bathroom.

Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on the evidence gathered throughout the investigation revealed that allegation 1, A child in care was not provided a safe and comfortable environment is substantiated and Allegation #2 Adult in home handled a child in care roughly.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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 3
Control Number 30-CC-20210419160305
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 197494080
VISIT DATE: 07/07/2021
NARRATIVE
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An exit interview was conducted with the Licensee, Jennifer Amador, in which this report was read to her. LPA provided licensee with a copy of this report, a Notice of Site Visit (LIC 9213) and Appeal rights by email due to technical issues.

Licensee was cited Type A deficiencies, according to California Code of Regulations Title 22 (see LIC 809D report for deficiencies). The Licensee was advised that the Notice of Site Visit and a copy of this report must be posted at the entrance of the facility for a period of 30 days.

In addition; A copy of this report must be provided to a parent or an authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

Licensee was advised to respond to this email in acknowledgment that a copy was received by email

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20210419160305
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 197494080
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2021
Section Cited
CCR
102423(a)(4)
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102423 (a)(4) Operation of a Family Child Care Home. To be free from corporal or unusual punishment, infliction of pain...
This requirement was not met as evidenced Based on Interview's of parents, chiidren and staff.
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Licensee will review video and provide proof of completion on Children's Personal Rights Issues
refer to the follwing link
https://ccld.childcarevideos.org/family-child-care-providers/
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Licensee staff member used corpal punishment to discipline children under care. This poses an immediate Health and Safety risk to children in care.
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Type A
07/07/2021
Section Cited
CCR
102423(a)(4)
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102423 (a)(4) Operation of a Family Child Care Home. To be free from...interference with... toileting.This requirement was not met as evidenced Based on Interview's of parents, chiidren and staff.
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Licensee will review video and provide proof of completion on Children's Personal Rights Issues

refer to the follwing link
https://ccld.childcarevideos.org/family-child-care-providers/
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Licensee instructed children to use the bathroom with the door open. This poses an immediate 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3