198014215-5-16-2019-33-CC-TCON-BCFRZS-20190523132823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198014215
Report Date: 05/16/2019
Date Signed: 05/16/2019 10:15:59 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
02/20/2019 and conducted by Evaluator Raul Navarro

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20190220141108

FACILITY NAME:	RUBALCABA FAMILY CHILD CARE		FACILITY NUMBER:	198014215
ADMINISTRATOR:	RUBALCABA, GRACIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 269-9741
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90063
CAPACITY:	12	CENSUS: 5	DATE:	05/16/2019
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Graciela Rubalcaba		TIME COMPLETED:	10:34 AM

ALLEGATION(S):

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Child was shut in room for long periods of time.
Lack of supervision resulted in child getting injured by another child(ren) on multiples occasions.
Child was left in soiled diapers for extended periods of time
Lack of supervision resulted in child getting bit by another child.
Licensee does not provide a safe environment for children.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced complaint inspection on this date for the purpose of delivering the findings for the above allegations. LPA met with Licensee Graciela Rubalcaba who guided the LPA on a tour of the facility. There were five children present during today's inspection. Also present was Licensee's spouse.

During the course of the investigation LPA interviewed the Complainant, Licensee, and parents. Complainant stated that their children were shut in a room for long periods of time. LPA interviewed the Licensee who denies the allegation. Per Licensee, the children sleep in one of the bedrooms. Per Licensee, the door to the room is semi closed so that noise does not wake up the sleeping children. Per Licensee she goes in the room to check on the children periodically.

*Report continues on the next page*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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-20190220141108

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: RUBALCABA FAMILY CHILD CARE	FACILITY NUMBER: 198014215
	VISIT DATE: 05/16/2019

NARRATIVE

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Complainant alleged that their child sustained multiple small scratches and bite marks due to lack of supervision. LPA interviewed the Licensee who denied the allegations. Per Licensee, the children are always supervised. Licensee also stated that the child had dried skin and would occasionally scratch himself. Licensee would apply lotion on the child. Per Licensee, she also suggested to Parent to cut he child's fingernails.

Complainant alleged that their child was not changed frequently and was left in soiled diapers. LPA interviewed the Licensee who denied the allegations. Per Licensee, she would change the child as needed. Per Licensee, she provided diapers to the child when the child ran out of diapers due to the child having diarrhea.

Complainant also alleged the children are allowed to play in the outside patio where gym equipment is present. LPA interviewed the Licensee who denied the allegation. Licensee stated that the gym equipment belongs to her downstairs neighbor and that she does not have access to that part of the property. LPA Navarro did observe during his inspection that the door leading to the steps that lead to the gym is locked with a chain and pad lock.

LPA Navarro also interviewed parents of the children in care. Parents interviewed did not disclosed any corroborating information. Parents interviewed stated that they are happy with the services provided by the Licensee.

Based on conflicting statements made by the complainant and parties interviewed, the LPA is unable to determine whether the allegations actually occurred. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated.

Exit interview was conducted with Licensee Graciela Rubalcaba . The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

Report ends- Page 2 of 2

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

LIC9099 (FAS) - (06/04)

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