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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017313
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:00:06 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
01/31/2022 and conducted by Evaluator Randy Derraco
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20220131150934
FACILITY NAME:PENA FAMILY CHILD CAREFACILITY NUMBER:
198017313
ADMINISTRATOR:PENA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 889-4104
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 3DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Licensee - Diana PenaTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Licensee left day car children unattended
Licensee allowed day care child to cry excessively
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced complaint inspection to the above address to deliver findings of the above allegations. LPA toured the facility and observed the home to be in good repair. There were two infants and one toddler in care upon arrival. Licensee's assistant was also present upon arrival

Based on observations made, interviews conducted and review of records, no disclosures were made regarding the above allegations. During the course of the investigation, LPA observed children in care to be in good spirits. Licensee was also observed to comfort a crying child until the child had stopped crying. LPA also observed the licensee to always have an assistant during each inspection visit. Parents interviewed disclosed that licensee and assistant would be present during drop off and pick up.

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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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 2
Control Number 54-CC-20220131150934
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: 03/30/2022
NARRATIVE
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No deficiencies will be cited today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights provided, and report was reviewed with the licensee Diana Pena.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2