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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700380
Report Date: 09/14/2021
Date Signed: 03/15/2022 04:33:10 PM

Substantiated


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
06/24/2021 and conducted by Evaluator Carol Heath
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210624083030
FACILITY NAME:FERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197700380
ADMINISTRATOR:FERNANDEZ, WELLZINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 434-3584
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: DATE:
09/14/2021
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Wellzina FernandezTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Licensee does not intervene in inappropriate behavior between children
INVESTIGATION FINDINGS:
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On 9/9/2021, Licensing Program Analyst (LPA) Carol Heath conducted a follow-up complaint inspection to the Fernandez Family Child Care and met with the Licensee Wellzina Fernandez. The purpose of the inspection was to deliver the findings for the above complaint allegation.

During the course of the investigation of this complaint, LPA Heath conducted interviews with children, licensees, and parents. Based on interviews, it was determined that the Licensee was not intervened in inappropriate behavior between children.

Based on the information obtained, there is a preponderance of the evidence that the aforementioned allegation occurredr. Therefore, the above allegation is Substantiated.

Appeal Rights were provided and discussed with the Licensee and the deficiency is being cited.

An exit interview was conducted and the report was reviewed with the Licensee, Wellzina Fernandez.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Maria Hendrix
LICENSING EVALUATOR NAME: Scott Herring
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
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-20210624083030
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700380
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/08/2021
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. ... Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidence by:
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The Licensee disagree the finding and refuse to give the plan of corrections
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Based on observatiions, interviews the licensee, children, parents and RP, the licensee did not rovide children an supervision which poses an immediated Health, Safety or Personal Rights Risk to children in Care.
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Deficiency Dismissed
Type B
09/08/2021
Section Cited
CCR
102423(a)(4)
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Personal Rights: 102423 (a)(4): To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.
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The Licensee disagree the finding and refuse to give the plan of corrections
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This requirement is not met as evidence by: Based on interviews with Licensee and parents, the licensee uses "Time-Out" to dispcipline the children. The child would standing on the corner which poses an which posed a potential Health, Safety or
Personal Rights risk to persons 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2