198011744-10-4-2021-33-CC-CGUA-C8LS8Y-20211109123956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198011744
Report Date: 10/04/2021
Date Signed: 10/04/2021 10:22:17 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/28/2021 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20210928082806

FACILITY NAME:	OLIVARES FAMILY DAY CARE		FACILITY NUMBER:	198011744
ADMINISTRATOR:	OLIVARES, FRANCISCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 304-1053
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	14	CENSUS: 3	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Francisca Olivares.		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Two unfingerprinted adults caring for children in day-care with no Criminal Background Clearance.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced inspection to investigate the above complaint allegation. Visit was conducted in Spanish. LPA met with Francisa Olivares, Licensee, who guided LPA on a tour of the facility at approximately 9:00 AM. The Licensee's husband, Carlos Olivares, Licensee's brother, Arturo Duque, and Licensee's sister in law, Ximena Cheuqueman, were also present.

During the course of the inspection LPA conducted interview with the Licensee and reviewed records. LPA obtained a copy of the facility roster. Based on the available information, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 1), are being cited on the attached LIC. 9099D. LPA observed that Arturo Duque and Ximena Cheuqueman do not have a criminal record clearance on file and have been living with the licensee for approximately 1 month. During this time, they have interacted with children during the hours of operation. LPA obtained a copy of the individuals' identification cards.

*REPORT CONTINUES ON NEXT PAGE

Substantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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 33-CC-20210928082806

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVARES FAMILY DAY CARE	FACILITY NUMBER: 198011744
	VISIT DATE: 10/04/2021

NARRATIVE

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This poses an immediate Health and Safety risk to clients in care. Civil penalties are being assessed.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to the Licensee.

Exit interview was conducted with Licensee. Appeal rights and procedures were explained.

*END OF INTERVIEW

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20210928082806

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVARES FAMILY DAY CARE	FACILITY NUMBER: 198011744
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/05/2021 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department	1 2 3 4 5 6 7	Licensee states she will get them fingerprinted as soon as possible. Licensee sent her husband with both individuals to get their live scan during this inspection. LPA will be sent a copy of the receipt by POC due date of 10/5/21.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by review of Criminal Record Clearance Associations to the Licensee's facility. It was observed that Arturo Duque, Licensee's brother and Ximena Cheuqueman, Licensee's sister in law do not have a criminal record clearance on file and have interacted with children. This is an immediate risk to the health and safety of children in care. Civil Penalities are being assesed.	8 9 10 11 12 13 14
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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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

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