198019425-12-3-2019-33-CC-CGAN-BJRNRX-20191211094212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019425
Report Date: 12/03/2019
Date Signed: 12/03/2019 05:07:38 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
08/23/2019 and conducted by Evaluator Crystal Green

COMPLAINT CONTROL NUMBER: 33-CC-20190823151632

FACILITY NAME:	RIVERA GUERRA FAMILY CHILD CARE		FACILITY NUMBER:	198019425
ADMINISTRATOR:	ANA MARGARITA RIVERAGUERRA		FACILITY TYPE:	850
ADDRESS:	232 N. HERBERT AVE.		TELEPHONE:	(323) 738-9706
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90063
CAPACITY:	14	CENSUS: 6	DATE:	12/03/2019
		UNANNOUNCED	TIME BEGAN:	04:10 PM
MET WITH:	Destiny Guerra		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Child sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Crystal Green conducted an unannounced follow-up complaint inspection to investigate the allegation above. Licensing staff met with Licensee Assistant, Destiny Guerra. Licensee, Ana Margarita Rivera Guerra, was not present during this inspection. Census was taken.

During this inspection, LPA attempted to interview children who attended the daycare between August 1, 2019 to November 30, 2019. Per Licensee Assistant and documentation provided, they are no children currently present who attended the daycare between the time frame specified. No children were interviewed during today’s inspection.

Exit interview was conducted with the Licensee. 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 inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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 1