198016007-4-6-2020-33-CC-CGUA-BNHTUK-20200409150229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016007
Report Date: 04/06/2020
Date Signed: 04/06/2020 05:02:31 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
11/18/2019 and conducted by Evaluator Betty Bell

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20191118133434

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198016007
ADMINISTRATOR:	HERNANDEZ, MARGARET		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 461-6036
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	14	CENSUS: 0	DATE:	04/06/2020
		UNANNOUNCED	TIME BEGAN:	09:49 AM
MET WITH:	Licensee Margaret Hernandez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff are not providing adequate supervision 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 five children.

This incident was reported to the Department by Licensee Hernandez via an Unusual Incident/Injury Report on 11/18/19.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (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)

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Control Number 33-CC-20191118133434

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 “Facility staff are not providing adequate supervision in care”:

The allegation refers to an incident which occurred on 11/15/19 in the backyard of the family child care home (FCCH) when the children were cleaning up after playing outside in order to prepare to come inside. Part of the clean up process is to ensure that the rocks go where the rocks belong--in the sandbox and not on the grass. In order to facilitate the process, Child #5 was throwing the rocks from the grass to the sandbox area instead of picking them up and carrying them over. At one point, when Child #5 threw one of the rocks, Child #1 was walking or running to where the rocks were and crossed the path of a rock Child #5 had thrown and got hit with a rock. By all eyewitness accounts, it was an accident, as Child #5 did not intend on hitting Child #1 with a rock.

According to all interviewed, Staff #1 was inside the house, feeding or changing an infant, and possibly had two other infants with her. According to three of the adults and three of the children interviewed, Staff #2 was outside with six or seven children when the accident happened. Staff #2 states that they did not see what happened because there was a lot going on, with children playing, running, and walking, and it happened so fast that Staff #2 did not notice when Child #1 got hit. Knowledge of what had occurred was gained by the accounts of four of the children interviewed. The rocks have since been removed from the backyard at the request of the parent of Child #1.

As it is unable to be determined whether Staff #2 was inside or outside and if she was outside, was just unable to prevent it in time, the allegation has been determined to be Unsubstantiated.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (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)

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Control Number 33-CC-20191118133434

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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This agency has investigated the complaint alleging there was a violation of Title 22, Division 12, Chapter 1, Article 06, Section 102417 “Operation of a Family Child Care Home.” The complaint alleged that “Facility staff are not providing adequate supervision in care.” Based upon the evidence as presented above, the allegation has been determined to be Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No citations are being issued for the allegation listed above.

An exit phone interview has been conducted with Licensee Margaret 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 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 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 so that they may be placed in the facility file.

A Notice of Site Visit was not provided to Licensee Hernandez since a physical inspection was not conducted.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (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)

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