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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198014215
Report Date: 01/22/2025
Date Signed: 01/22/2025 10:24:29 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 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
12/09/2024 and conducted by Evaluator Nolan Tcheng
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20241209230447
FACILITY NAME:RUBALCABA FAMILY CHILD CAREFACILITY NUMBER:
198014215
ADMINISTRATOR:RUBALCABA, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 604-9050
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:12CENSUS: 7DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Graciela Rubalcaba - LicenseeTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Licensee did not provide a healthful accommodation for a daycare child while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced complaint inspection for the purpose of delivering complaint findings. Upon arrival at 9:35am, LPA met with Licensee Graciela Rubalcaba, to whom the purpose of the inspection was explained. A tour of the facility was provided.

Census was taken. There were 7 children with 2 staff members.

During the course of the investigation, interviews were conducted with two staff members and six parents. Documentation in the form of child care facility roster was obtained. Text messages screenshots were also obtained.

Information from the complainant, indicates that a child was left in a soiled diaper for an extended amount of time that resulted in a rash.

REPORT CONTINUES PAGE 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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 3
Control Number 33-CC-20241209230447
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RUBALCABA FAMILY CHILD CARE
FACILITY NUMBER: 198014215
VISIT DATE: 01/22/2025
NARRATIVE
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LPA conducted interview with facility staff. Licensee states that they check the children’s diapers 5 to 6 times a day. Per licensee, they are the only ones on staff that conduct diaper changes. Diapers are changed when they smell and when the child first arrives. Licensee explained that rashes are normal and that they have observed them before, responding to them with creams or Vaseline.

Parents were interviewed regarding the allegation. Parent #3 stated that they had picked up their child from the facility with a soiled diaper. They stated they had also observed their child with redness from the diaper but stated there were no rashes. During interview, Parent #4 stated that their diaper needs were not always satisfied. Parent #4 stated “[They] did come home with some diaper rash. I remember [they] had a really bad rash. The skin was almost like cut.” Interviews determined that there has been past occurrences of redness and rash from diapers while in care.

Based on LPA’s interviews which were conducted, 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 1 102423 Personal Rights), are being cited on the attached deficiencies page.”)

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Graciela Rubalcaba, at 10:30am. Copy of Report provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20241209230447
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RUBALCABA FAMILY CHILD CARE
FACILITY NUMBER: 198014215
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2025
Section Cited
CCR
102423(a)(2)
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Personal Rights
To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.


This requirement is not met as evidenced by:
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Per Licensee, will create a diaper log of the time they change diapers each day for each child that needs it. They will note if any creams or ointment was given to child. Parent will sign diaper changing log at end of the day. Copy of logg will be submitted by POC date.
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Based on interview, Licensee did not ensure that children in care had their diapers changed in a timely manner, resulting in children developing a diaper rash. This was a potential risk to the to health, safety, and personal rights of 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.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3