198018861-10-31-2022-54-CC-VCOK-CKS587-20221101194325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198018861
Report Date: 10/31/2022
Date Signed: 10/31/2022 04:31:11 PM

Substantiated

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
08/02/2022 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220802153917

FACILITY NAME:	ANDRADE & CRUZ FAMILY CHILD CARE		FACILITY NUMBER:	198018861
ADMINISTRATOR:	A., CLAUDIA & C., HUMBERTO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 519-6817
CITY:	HAWAIIAN GARDENS	STATE: CA	ZIP CODE:	90716
CAPACITY:	14	CENSUS: 3	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Claudia Andrade, Licensee		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Infants in care are not provided appropriate sleeping arrangements

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Alicia Mooberry for the purpose of delivering findings of the above allegation. Upon arrival, LPA met with Jaqueline Ajvix whi was supervising three (3) children. Licensee arrived at 3:03pm. LPA toured areas were children were present.

The complainant stated that children were observed sleeping in the facility's unpermitted garage. LPA observed two (2) playpens and sleeping cots in the garage. Witness interviews confirmed that children in care sleep in the garage. Based on LPA observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. California Code of Regulations, Title 22 102416.3(a)(1) are being cited on the attached LIC9099D.

Report Continues on Next Page

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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-20220802153917

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
	VISIT DATE: 10/31/2022

NARRATIVE

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Licensee states that children sometimes fall asleep in the garage. Licensee provided a written plan to ensure that children who fall asleep in the garage are immediately taken to the living room inside the home.

Upon receipt of this report, the licensee shall post any licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the Parent Notification Requirements was provided to the licensee, along with a copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
08/02/2022 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220802153917

FACILITY NAME:	ANDRADE & CRUZ FAMILY CHILD CARE		FACILITY NUMBER:	198018861
ADMINISTRATOR:	A., CLAUDIA & C., HUMBERTO		FACILITY TYPE:	810
ADDRESS:	12243 TILBURY ST.		TELEPHONE:	(562) 519-6817
CITY:	HAWAIIAN GARDENS	STATE: CA	ZIP CODE:	90716
CAPACITY:	14	CENSUS: 3	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Claudia Andrade, Licensee		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility was out of ratio
lack of supervision
Infants in care are left in car seats

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Alicia Mooberry for the purpose of delivering findings of the above allegations. Upon arrival, LPA met with Jaqueline Ajvix who was supervising three (3) children. Licensee arrived at 3:03pm. LPA toured areas were children were present.

LPA observations, Interviews conducted and documentation reviewed did not support nor confirm the above allegations. LPA conducted inspections on two separate occasions and did not observed the facility out of ratio nor children's personal right being violated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Report Continues on Next Page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 54-CC-20220802153917

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
	VISIT DATE: 10/31/2022

NARRATIVE

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Exit interview was conducted with licensee Claudia Andrade . The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 54-CC-20220802153917

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/31/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/31/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	102423 (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement was not met as evidence by	1 2 3 4 5 6 7	Licensee removed the cots from the garage and provided a written plan to ensure children don't sleep in the non-permitted garage.
	8 9 10 11 12 13 14	Based on LPA observations and witness interviews, children are sleeping in the unpermitted garage. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

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