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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011719
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:49:29 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
06/24/2021 and conducted by Evaluator Tiffanie Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20210624163531
FACILITY NAME:RANGEL FAMILY CHILD CAREFACILITY NUMBER:
198011719
ADMINISTRATOR:RANGEL, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 291-4910
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:14CENSUS: 4DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Evangelina Range, LicenseeTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Personal Rights- Lack of supervision resulting in daycare child got injured.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) T. Tran arrived at the above facility to conduct a subsequent complaint inspection for the purpose of concluding for the aforementioned complaint allegation. LPA met with licensee Evangelina Rangel.
Based on records review and interviews conducted. Licensee admitted on 02/25/2020, while licensee was in the backyard cleaning and did not observed C1(see LIC811) got injured on the lower lip by another child while in care. C1 sustained a cut on the lower lip therefore, based on the preponderance of evidence, licensee failed to properly supervise a child in care and personal rights was substantiated. A finding means that the complaint is substantiated, and the allegation is valid because the preponderance of the evidence standard has been met.
Type B deficiency was cited. Please see Complaint Investigation Report LIC 9099D for deficiency cited. An exit interview was conducted with the licensee. This report and notice of site visit were provided.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 54-CC-20210624163531
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: RANGEL FAMILY CHILD CARE
FACILITY NUMBER: 198011719
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
CCR
102423(a)(2)
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Personal Rights
This requirement is not met as evidenced by based on record review and interviews licensee failed to provide adequate care for C1, child sustained a cut on the lower lip by a another child in care which poses a potential health and safety risk to children in care.
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Licensee agrees to view (Parents and Resources videos) that are available on the department website at ccld.childrenvideos.org view at least one video pertains to care & supervision then submit a short summary to LPA by or before 09/10/2021 in order to clear this citation.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
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