198019425-9-17-2019-33-CC-CGAN-BJRNRY-20191211094212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019425
Report Date: 09/17/2019
Date Signed: 09/17/2019 03:54:57 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

PUBLIC

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: 3	DATE:	09/17/2019
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Ana Margarita Rivera Guerra		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Child sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Crystal Green and Mireya Garcìa conducted an unannounced follow-up complaint inspection to investigate the allegation above. Licensing staff met with Licensee, Ana Margarita Rivera Guerra, who guided analysts on a tour of the facility also present was Licensee's Assistant, Destiny Guerra. LPA Garcìa assisted with translating due to licensee primary language being Spanish. Census was taken.

Allegation states child sustained unexplained injury while in care. Reporting Party (RP) alleges on 08/16/18, child #1 came home with a big bump on his forehead above his right eye. Per RP, child #1 is no longer attending the facility. During this inspection, LPAs observed the home to have security cameras on the premises however when licensing staff requested to review camera footage, Licensee Assistant informed that the camera system had not been recording during the time in question.

Report Continues Page 1 of 2.

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: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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-20190823151632

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: RIVERA GUERRA FAMILY CHILD CARE	FACILITY NUMBER: 198019425
	VISIT DATE: 09/17/2019

NARRATIVE

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During this investigation, Licensing staff conducted interviews with the Licensee and Licensee Assistant. Per both Licensee and Licensee Assistant, On 08/16/19, child #1 arrived at the facility with an unexplained bruise on his forehead. Licensee Assistant obtained a picture of child #1 on the day in question due to observing him with an unexplained bruise.

Due to inconsistency in statements obtained during this investigation, at this time there is not enough evidence to support the RP allegation that child sustained unexplained injury while in care. Therefore, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore at this time the above allegations are unsubstantiated. At this time no deficiencies are being cited.

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.

Report Ends Page 2 of 2.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC9099 (FAS) - (06/04)

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