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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494080
Report Date: 05/18/2021
Date Signed: 05/18/2021 04:30:08 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
03/03/2021 and conducted by Evaluator Laticia S Thompson
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210303132228
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: 10DATE:
05/18/2021
UNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Jennifer AmadorTIME COMPLETED:
02:22 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights-Children Fight during Care
Personal Rights-Licensee inappropriately discipline Children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On at 05/18/2021 at 2:02pm Licensing Program Analyst (LPA) Laticia Thompson conducted an unannoced vist to Amador Family Child Care Home. LPA met with licensee, Jennifer Amador, LPA advised licensee the reason for the visit is to deliver the findings of the complaint received on 03/03/2021 regarding the allegations referenced above. LPA observed 10 children and 03 adults.

Based on the information gathered throughout the course of the investigation,
allegation 1 that children fight will under care at the facility and allegation 2 licensee inappropriately disciplines children,” are SUBSTANTIATED, this means that the allegations are valid because the preponderance of the evidence standard has been met. The investigation findings has been based on interviews conducted with children, parents, staff and LPA’s observations.




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: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
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 5
Control Number 30-CC-20210303132228
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: 05/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2021
Section Cited
CCR
102423(a)(1)
1
2
3
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6
7
102423 (a)(1) Operation of a Family Child Care Home. To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidenced Based on
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2
3
4
5
6
7
The licensee will watch a Child Care Video on Children's Personal Rights in Child Care and provide a written statement on what she learned and how she will ensure she provides certain rights to day care children.
(https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/).
8
9
10
11
12
13
14
Interview's of parents, chiidren and licensee. Children were physically involved in fights with one another. This poses an immediate Health and Safety risk to children in care.
8
9
10
11
12
13
14
Link also emailed to licensee. Statement is due on 05/24/2021.
Type B
05/18/2021
Section Cited
CCR
102423(a)(4)
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2
3
4
5
6
7
102423 (a)(4)1) Operation of a Family Child Care Home To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, This requirement was not met as evidenced based on
1
2
3
4
5
6
7
The licensee will watch a Child Care Video on Children's Personal Rights in Child Care and provide a written statement on what she learned and how she will ensure she provides certain rights to day care children.
(https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/).
8
9
10
11
12
13
14
Interveiws conducted and LPA's observation. Licensee speaks to children in an elevated and intimidating tone..
This poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
Link also emailed to licensee. Statement is due on 05/24/2021.
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: 05/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/03/2021 and conducted by Evaluator Laticia S Thompson
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210303132228

FACILITY NAME:AMADOR FAMILY CHILD CAREFACILITY NUMBER:
197494080
ADMINISTRATOR:AMADOR, JENNIFERFACILITY TYPE:
810
ADDRESS:4231 W. 139TH STREETTELEPHONE:
(310) 701-6687
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 10DATE:
05/18/2021
UNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Jennifer AmadorTIME COMPLETED:
02:22 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights-Child was bitten by licensee's dog
Personal Rights-Day care child not being provided an adequate amount of food
Personal Rights-Infant left in soliled clothing
Personal Rights-Knives are acessible to children
Personal Rights-Licenseee is away from the home more than 20% of the time during day care hours
Personal Rights-Licensee does not live in home
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On at 05/18/2021 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannouced vist to Amador Family Child Care Home. LPA met with Jennifer Amador (licensee). LPA advised licensee the reason for the visit today is to deliver the findings of the complaint received on 03/03/2021 regarding the allegations referenced above. LPA observed 10 children and 3 adults.

During the investigation of Allegation 1 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. LPA interviewed Parents and Children and was unable to confirm that any children within the facility was bitten by the dog.
During the investigation of Allegation 2 revealed there is not sufficient evidence to support nor deny that the allegation occurred. Based on interviews and review of records LPA was unable to confirm if children were not provided an adequate amount of food.

contiued (9099C)




Unsubstantiated
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: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
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 5
Control Number 30-CC-20210303132228
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: 05/18/2021
NARRATIVE
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5
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During the investigation of Allegation 3 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. Based on LPA's observation and parent interviews, LPA was unable to determine if infants were left in soiled clothing.
During the investigation of Allegation 4 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. Based on LPA's observation and parent interviews, LPA was unable to determine that knives were accessible to children.
During the investigation of Allegation 5 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. Based on LPA's interviews of parent, LPA was unable to determine that licensee is away from the home more than 20% of the time during day care hours.
During the investigation of Allegation 5 revealed, there is not sufficient evidence to support nor deny that the allegation occurred. Based on LPA's interviews of parent and review of records LPA was unable to determine that licensee does not live in home.

Unsubstantiated: A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.


An exit interview was conducted via Tele-Visit with the Licensee, Jennifer Amador, in which this report was read to her. A copy of this report, a Notice of Site Visit (LIC 9213) and Appeal rights will be emailed to Licensee today. LPA explained to licensee to reply to the email as acknowledgment of receipt. Licensee must print and sign the Facility Evaluation Report (LIC 9099). The licensee is required to mail or deliver the signed report to the El Segundo Regional Office within 3 business days.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 30-CC-20210303132228
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: 05/18/2021
NARRATIVE
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Licensee was cited Type A deficienc(ies) and Type B deficiencies, according to California Code of Regulations Title 22.

A copy of this report must be copied and given to all parents currently enrolled and to the parents of any child enrolling in the facility within the next 12 months. LPA provided a copy of the form LIC 9224 Acknowledgement of receipt of Licensing Report.

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 these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5