198017313-7-21-2021-54-CC-TCON-C5QVAB-20210809161538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198017313
Report Date: 07/21/2021
Date Signed: 07/21/2021 10:25:58 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 CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2021 and conducted by Evaluator Katrina Chicote

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20210520171659

FACILITY NAME:	PENA FAMILY CHILD CARE		FACILITY NUMBER:	198017313
ADMINISTRATOR:	PENA, DIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 889-4109
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	14	CENSUS: 3	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Licensee, Diana Pena		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Personal Rights - Licensee is under the influence while providing care and supervision to day-care children.
Operation of a Family Child Care Home - Day-care children are left unsupervised

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced complaint inspection on 07/21/2021 at 9:15 AM to conclude the investigation of the above allegations. LPA toured facility with licensee, Diana Pena. There were one infant and one toddler present during this visit. LPA observed another infant being dropped off at 10:05 AM, making it a total of two infants and two toddlers present at facility at time of inspection.

During the course of this investigation, LPA interviewed licensee, staff, parents, children and other adults. All pertinent documentation was collected. No disclosures were made regarding the above allegations from interviews conducted. During multiple observations of facility, LPA observed children playing in the backyard for outdoor play with an adult at time of inspections, per Licensee, her and Assistant are always with children whenever they are playing inside or outside.

Report Continues - Page 1 of 2

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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 54-CC-20210520171659

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PENA FAMILY CHILD CARE	FACILITY NUMBER: 198017313
	VISIT DATE: 07/21/2021

NARRATIVE

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Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies will be cited today.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Diana Pena, Licensee, including, but not limited to Appeal Procedures and Agencies Consultative Role.

Report Ends - Page 2 of 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC9099 (FAS) - (06/04)

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