198019677-3-24-2023-54-CC-KCHS-CQKSLS-20230404135849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019677
Report Date: 03/24/2023
Date Signed: 03/24/2023 05:47:45 PM

Unsubstantiated

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
01/04/2023 and conducted by Evaluator Mayra Rivera

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20230104100728

FACILITY NAME:	MARTINEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019677
ADMINISTRATOR:	LORENA MARTINEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 427-4708
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90011
CAPACITY:	14	CENSUS: 3	DATE:	03/24/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Lorena Martinez, Licensee		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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,Licensee allows uncleared adult to live in the home
Licensee is operating over capacity
Licensee not adequately supervising day care child resulting in injuries

INVESTIGATION FINDINGS:

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On Friday, March 24, 2023 at 2:15 p.m., Licensing Program Analyst (LPA), Mayra Rivera arrived at the above licensed facility to conduct an unannounced subsequent complaint inspection for the purpose of concluding the investigation of the above allegation.

Upon arrival, LPA met with Licensee Lorena Martinez and observed 3 children in care.

During the course of this investigation LPA Rivera conducted interviews with parents and children. Of the 5 interviews conducted with parents, one disclosed that their child has sustained scratches and had concerns. The other four disclosed their children have not sustained injuries while in care and had no concerns. All 5 parent interviews stated they have not seen uncleared adult in the home. LPA Rivera interviewed complainant and they disclosed that they have not seen the uncleared adult in the facility. Prior to the incident, did not have concerns while attending care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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-20230104100728

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: MARTINEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019677
	VISIT DATE: 03/24/2023

NARRATIVE

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Based on the evidence obtained during the course of the investigation through interviews and record reviews, C1 tried to step over a plastic ball and fell which sustained and a reddish marking on the cheek and parent was contacted via text. Witness 1 was outside with the children and observed the incident when C1 was trying to step on the ball. Based on interviews, there is no indication of an uncleared adult living in the home or provider being over capacity or provider not adequately supervising day care child resulting in injuries.

This agency has investigated the complaint alleging Licensee allows uncleared adult to live in the home, Licensee is operating over capacity, and Licensee not adequately supervising day care child resulting in injuries

At this time, it is determined that although the allegation 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 allegation is unsubstantiated.

Exit interview was conducted with Licensee, Lorena Martinez.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra Rivera	TELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

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