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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198012910
Report Date: 12/08/2020
Date Signed: 12/08/2020 12:23:40 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 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
12/02/2020 and conducted by Evaluator Seung Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201202093256
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198012910
ADMINISTRATOR:JIMENEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 633-2083
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:14CENSUS: 12DATE:
12/08/2020
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Veronica JimenezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Over Capacity.
Fire extinguisher and smoke detector not working.
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA's) Seung Lee and Judy Mora conducted an unannounced complaint inspection. Upon arrival LPAs met with Licensee Veronica Jimenez, who was present with 12 children and 1 assistant.

The complaint alleged that the Licensee was Over Capacity. The complaint also alleged that the fire extinguisher and smoke detector were not working.

During the unannounced inspection LPAs observed that out of the 12 children present, 5 children were under the age of 2. This is an immediate risk to children in care. A large family child care home is permitted to provide care for a maximum of 4 infants when the total capacity is 12 children with an assistant. During the inspection it was also observed that the Fire extinguisher was purchased in the last year and the smoke detector in the home was operational.

*REPORT CONTINUES ON NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2020
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 5
Control Number 33-CC-20201202093256
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 12/08/2020
NARRATIVE
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However, LPAs obtained a copy of a inspection report from the fire department dated 12/01/2020 which indicated the Licensee was cited for the fire extinguisher and smoke detector. This is a potential risk to children in care. A large Family Child Care Home is required to comply with the standards of the local Fire department.

Based on the LPAs observations, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22 102416.5 (d) (2) and 102417 (g) (1) is being cited on the attached 9099D (deficiency page).

The notice of site inspection along with all pages of this report must be posted for a period of 30 days during hours of operation failure to maintain posting will result in a civil penalty of $100.00 dollars. LPA Lee provided the facility with a copy of the LIC 9224 form which will need to be signed by all current and future parents for one year from this date. Exit interview conducted with Licensee. Appeal Rights provided and explained.


*END OF REPORT
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 33-CC-20201202093256
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/09/2020
Section Cited
CCR
102416.5(d)(1)
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Operation of Family Child Care Home

For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant
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Licensee stated she will make sure to comply with proper staff-children ratio.
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provider's children under age 10, shall be either:Twelve children, no more than four of whom may be infants. LPAs observed the Licensee was providng care for 5 infants. This is an immediete risk to children 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.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20201202093256
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2020
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home

Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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Licensee has already corrected deficiency.
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LPA obtained a copy of a report from the Fire department citing the Licensee for the smoke detector and Fire extinguisher. This is a potential risk to children 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.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5