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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011139
Report Date: 02/09/2021
Date Signed: 02/10/2021 03:24:43 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2020 and conducted by Evaluator Katrina Chicote
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20201209162342
FACILITY NAME:MATEOS FAMILY CHILD CAREFACILITY NUMBER:
198011139
ADMINISTRATOR:MATEOS, LUCILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 752-3914
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:14CENSUS: 2DATE:
02/09/2021
UNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Lucila Mateos, LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Daycare child had an unexplained injury.
INVESTIGATION FINDINGS:
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On 02/09/2021 at 11:57 AM, Licensing Program Analyst (LPA) Katrina Chicote met with Licensee, Lucila Mateos, for the purpose of an unannounced complaint investigation for the above allegation. Due to COVID-19 and precautionary measures, interviews and visit was conducted via tele-inspection using FaceTime. LPA observed two children in care at time of tele-inspection. Licensee's daughter was present at inspection and assisted with English-Spanish translation.

During the course of this investigation, LPA interviewed Reporting Parties (RPs), Licensee, Licensee's Assistant, adults and children, both current and those that previously attended facility. All pertinent documentation was collected. Licensee's interview with Spanish-speaking LPA revealed that Child 1 disclosed that injury occurred at grandma's house, but Child 1 did not disclose this during interview with LPA. LPA discussed with Licensee the importance of doing morning health checks to children in care, and Licensee stated she is developing a plan to conduct morning health checks to avoid incidents like this in the future. LPA also discussed the importance of submitting Unusual Incident Reports to The Department. There
Report Continues Next Page - Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021
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 54-CC-20201209162342
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MATEOS FAMILY CHILD CARE
FACILITY NUMBER: 198011139
VISIT DATE: 02/09/2021
NARRATIVE
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were no corroborating disclosures made regarding the above allegation from interviews conducted with adults and children.

Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies will be cited today.

The Notice of Site Visit (LIC 9213) -- must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain will result in a civil penalty of $100.00

Exit interview was conducted with Lucila Mateos, Licensee, including, but not limited to Appeal Procedures and Agencies Consultative Role.
Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2