197700420-8-31-2021-12-CC-CBEL-C7XU7E-20211019151947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197700420
Report Date: 08/31/2021
Date Signed: 08/31/2021 05:07:02 PM

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
08/25/2021 and conducted by Evaluator Brigitte Tsutaoka

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20210825163021

FACILITY NAME:	VASQUEZ FAMILY CHILD CARE		FACILITY NUMBER:	197700420
ADMINISTRATOR:	THERESA DE JESUS VASQUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(747) 218-7295
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	14	CENSUS: 4	DATE:	08/31/2021
		UNANNOUNCED	TIME BEGAN:	02:27 PM
MET WITH:	Theresa Vasquez		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Allegation 1: Facility is in disrepair

INVESTIGATION FINDINGS:

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On August 31, 2021at 2:27PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced complaint inspection on the above allegation. LPA disclosed the purpose of inspection and was granted entry by Licensee's Spouse who guided LPA on a tour of the facility. During initial entry, Licensee was not present at the facility and no children were present because Licensee was conducting child pick ups at the nearby elementary school.

At 2:45PM, Licensee's Spouse guided LPA outside to the back yard. LPA observed 2 broken windows with broken glass in the day care room. Licensee's spouse stated the windows were broken during construction a couple days ago. The broken windows are made inaccessible from the inside by book cases and a locked cabinet. Licensee spouse then guided LPA upstairs and LPA observed the broken glass window with tape in the off-limits second story room with swamp cooler secured to it.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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 4

Control Number 12-CC-20210825163021

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: VASQUEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700420
	VISIT DATE: 08/31/2021

NARRATIVE

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At 2:53PM, Licensee returned with 3 children, and Licensee's spouse left with their child to complete pick ups from school and LPA conducted interview. Licensee disclosed the upstairs window has been broken since they moved in March of 2020 and the children do not have access to upstairs as it is off-limits. Licensee concurred the window in the day care room was broken during construction. During interview, 1 child was picked up.

At 3:15, Licensee's spouse returned with 3 children for a total of 4 present during inspection.

Based on observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found Substantiated. California Code of Regulations, Title 22, Division 12 Chapter 1 102417(g) Operation of a Family Child Care Home Type B violation is being cited.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Licensee.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 12-CC-20210825163021

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: VASQUEZ FAMILY CHILD CARE	FACILITY NUMBER: 197700420
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/31/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/14/2021 Section Cited CCR 102417(g)	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child... This requirement was not met as evidence by:	1 2 3 4 5 6 7	License agreed to have all three windows repaired no later than 9/14/2021 and provide pictures to the Department by deadline.
	8 9 10 11 12 13 14	Based on observation and interview, Licensee failed to repair the two broken windows in the day care room and window in upstairs room which poses a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4