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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198016007
Report Date: 04/06/2020
Date Signed: 04/06/2020 05:38:54 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
01/14/2020 and conducted by Evaluator Betty Bell
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20200114140108
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
198016007
ADMINISTRATOR:HERNANDEZ, MARGARETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 461-6036
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:14CENSUS: 0DATE:
04/06/2020
UNANNOUNCEDTIME BEGAN:
03:21 PM
MET WITH:Licensee Margaret HernandezTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Day care child sustained an unexplained injury while in care.

Day care child's diapering needs were not met while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emiko Bell contacted the facility on 04/06/20 via telephone due to COVID-19 and precautionary measures in order to provide the findings of the Complaint investigation. Licensee Margaret Hernandez answered the phone. LPA Bell stated the purpose of the call to Licensee Hernandez.

Census: There were no other adults or children present with licensee, as licensee closed down for precautionary measures on 03/16/20.

Throughout the course of the investigation, interviews were conducted with four adults (including the Reporting Party) and two children.

This incident was reported to the Department by Licensee Hernandez via an Unusual Incident/Injury Report on 01/15/20.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2020
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-20200114140108
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016007
VISIT DATE: 04/06/2020
NARRATIVE
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-Pertaining to the allegation that “Day care child sustained an unexplained injury while in care”:
The allegation refers to an incident which occurred on 01/13/20 when Child #1 was dropped off for their first day in care at 6:30 A.M. without any visible marks on their face and when they were picked up at 6:00 P.M. that evening, scrapes were observed on the tip of their nose, underneath their nose, and underneath their top lip, as well as a swollen upper lip. Both Staff #1 and Staff #2 state that they are not aware of anything which may have happened to Child #1 (e.g. Child #1 falling or getting hit or bumping into something). Two children interviewed by Staff #1 said that Child #1 fell; the two children interviewed by LPA corroborated that Child #1 fell. However, as neither Staff #1 nor Staff #2 witnessed what actually occurred to or with Child #1, the allegation has been determined to be Substantiated.

Based on interviews conducted, licensee did not ensure that children in care are supervised at all times, which poses an immediate risk to the Health, Safety, or Personal Rights risk to the children in care.

This agency has investigated the complaint alleging that “Day care child sustained an unexplained injury while in care.” Based upon the evidence as listed above, the preponderance of evidence standard has been met and the allegation has been determined to be Substantiated. A finding of Substantiated means that the allegation has been found to be valid because the preponderance of the evidence standard has been met. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102417 “Operation of a Family Child Care Home” is being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 33-CC-20200114140108
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016007
VISIT DATE: 04/06/2020
NARRATIVE
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-Pertaining to the allegation that “Day care child's diapering needs were not met while in care”:

The allegation refers to 01/13/20 when Child #1 was dropped off at 6:30 A.M. without a diaper rash and was picked up at 6:00 P.M. with a diaper rash. This was the child’s first day in care.

Both Staff #1 and Staff #2 state that they do not keep record of what time diapers are checked and/or changed (it is not required for Family Child Care Homes). Staff #1 claims to change diapers every one and a half to two hours. However, when asked how many times Child #1 was changed that day, it was stated that the child was changed three times, once in the morning, once at around 2:00 and another time that was unknown. Staff #1 was informed by the parent of Child #1 at approximately 2:00 P.M. that the child had sensitive skin. Staff #1 acknowledged that when Child #1 was picked up that day, they had a “little” diaper rash.

Staff #2 states that they changed the diaper of Child #1 at 3:30. Staff states that the child had a bowel movement and had urinated and acknowledges that the child’s bottom was “red” and “had a little bit of a rash.” Staff #2 acknowledges that this was the only time they changed the child during their shift, which was from 12:00-6:00.

As the child was present at the daycare for eleven and a half hours (11.5) and was changed at the most three times, and as LPA received photos of the diaper rash on Child #1, the allegation has been determined to Substantiated.

This agency has investigated the complaint alleging that “Day care child's diapering needs were not met while in care.” Based upon the evidence as listed above, the preponderance of evidence standard has been met and the allegation has been determined to be Substantiated. A

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 33-CC-20200114140108
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016007
VISIT DATE: 04/06/2020
NARRATIVE
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finding of Substantiated means that the allegation has been found to be valid because the preponderance of the evidence standard has been met. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102423 “Personal Rights” is being cited on the attached LIC 9099D.

Please refer to 9099D for documentation of deficiencies.



Upon receipt, Licensee Margaret Hernandez shall post the 9099D page. The 9099D page shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next twelve (12) months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent.

An exit phone interview has been conducted with Licensee Hernandez. Appeal Rights were verbally explained to Licensee Hernandez as well. A copy of this report has been signed by LPA Bell. This report along with form LIC 9224 and the Appeal Rights will be scanned via e-mail to Licensee Hernandez, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report, form LIC 9224 and the Appeal Rights has been placed in today’s mail and Licensee Hernandez agrees to sign the bottom of each page of the 9099 and return the originals to LPA Bell in-person or via U.S. Mail.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 33-CC-20200114140108
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016007
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/07/2020
Section Cited
CCR
102417(a)
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OPERATION OF A FAMILY CHILD CARE HOME
The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

-This requirement is not met as evidenced by: when picked up on 01/13/20, Child #1 was
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Per Licensee Hernandez, she will write a statement attesting that she will always be where the daycare children are except when she goes to pick up school-age children and she will ensure that the children are in the living room watching TV when she leaves. She will provide her statement to CCL by the POC due date of 04/07/20.
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observed to have scrapes on the tip of their nose, underneath their nose, and underneath their top lip, as well as a swollen upper lip. Staff #1 and Staff #2 are not aware of how Child #1 sustained these injuries. This poses an immediate Health, Safety, or Personal Rights risk to the children in care.
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Type A
04/16/2020
Section Cited
CCR
102423(a)(2)
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PERSONAL RIGHTS
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Per Licensee Hernandez, she will begin documenting the times that she changes diapers and any observations she makes (e.g. diaper rash). She will provide a sample of the log to CCL by the POC due date of 04/07/20.
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-This requirement is not met as evidenced by: when Child #1 was picked up at 6:00 P.M., a diaper rash was noted. The child had been present since 6:30 A.M. Staff #1 stated that the child's diaper had been changed three times; Staff #2 was present from 12:00-6:00 and stated that the child had only been changed once during those six hours.
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This poses an immediate Health, Safety, or Personal Rights risk to the children in care.
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: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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