198019934-6-28-2022-54-CC-VCOK-CGGUER-20220719153135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019934
Report Date: 06/28/2022
Date Signed: 06/28/2022 02:31:20 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
06/23/2022 and conducted by Evaluator Monique Ayala

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220623121704

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019934
ADMINISTRATOR:	MARIA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 440-3286
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	14	CENSUS: 6	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Licensee, Maria Hernandez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not properly report an incident involving a daycare child.

INVESTIGATION FINDINGS:

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

On 06/28/2022 at 12:40 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Maria Hernandez. The purpose of the inspection was to inform the provider that a complaint investigation was being conducted due to the allegation noted above. Based on the information and supporting documentation obtained during the inspection, LPA was able to provide the complaint investigation findings.

During the inspection, LPA toured the facility accompanied by the Licensee. There were six children and one other adult present when the visit began. During the investigation, LPA conducted a record review of the child's (C1) file and took photographs of pertinent documents. LPA conducted interviews with the Licensee and Licensee's Assistant (S1). LPA also obtained supporting documentation from the Licensee via text message, which consisted of multiple text messages between the child's (C1) parent.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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 4

Control Number 54-CC-20220623121704

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: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019934
	VISIT DATE: 06/28/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee disclosed that she was notified on 06/22/2022 that a child enrolled in care was diagnosed with hand, foot and mouth disease. The last day that the child was in care was on 06/08/2022. The Licensee provided proof via photographs that the child did not have a rash, blemishes or any indications of being ill while in care. Licensee stated that she asked other parents/guardians if there children showed any signs of having a fever, rash, or spots. Licensee denied being notified by any other parent that their child was ill or diagnosed with anything. Licensee did not obtain a doctor's note from the child's parent/guardian for the diagnosis.

Licensee did not report to the Department that she was notified of the diagnosis. During the inspection, LPA advised the Licensee of reporting requirements. Licensee completed an Unusual Incident/Injury Report (LIC 624) and provided a copy of the report to LPA.

Based on the information obtained, there is a preponderance of the evidence to prove that Licensee, Maria Hernandez failed to report the incident to the Department per Title 22, Reporting Requirements. Therefore, the allegation is substantiated. LPA issued an Advisory Note - Technical Violation (LIC 9102TV) to the Licensee.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted and a copy of this report was provided to Licensee, Maria Hernandez.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
06/23/2022 and conducted by Evaluator Monique Ayala

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220623121704

FACILITY NAME:	HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019934
ADMINISTRATOR:	MARIA HERNANDEZ		FACILITY TYPE:	810
ADDRESS:	9050 GAYMONT AVE		TELEPHONE:	(562) 440-3286
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	14	CENSUS: 6	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Licensee, Maria Hernandez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Daycare child sustained an infection while in care.

INVESTIGATION FINDINGS:

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

On 06/28/2022 at 12:40 pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Maria Hernandez. The purpose of the inspection was to inform the provider that a complaint investigation was being conducted due to the allegation noted above. Based on the information and supporting documentation obtained during the inspection, LPA was able to provide the complaint investigation findings.

During the inspection, LPA toured the facility accompanied by the Licensee. There were six children and one other adult present when the visit began. During the investigation, LPA conducted a record review of the child's (C1) file and took photographs of pertinent documents. LPA conducted interviews with the Licensee and Licensee's Assistant. LPA also obtained supporting documentation from the Licensee via text message, which consisted of multiple text messages between the child's (C1) parent.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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 4

Control Number 54-CC-20220623121704

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: HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019934
	VISIT DATE: 06/28/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Licensee disclosed that she was notified on 06/22/2022 that a child enrolled in care was diagnosed with hand, foot and mouth disease. The last day that the child was in care was on 06/08/2022. The Licensee provided proof via photographs that the child did not have a rash, blemishes or any indications of being ill while in care. Licensee stated that she asked other parents/guardians if there children showed any signs of having a fever, rash, or spots. Licensee denied being notified by any other parent that their child was ill or diagnosed with anything. Licensee did not obtain a doctor's note from the child's parent/guardian for the diagnosis.

Licensee did not report to the Department that she was notified of the diagnosis. During the inspection, LPA advised the Licensee of reporting requirements. Licensee completed an Unusual Incident/Injury Report (LIC 624) and provided a copy of the report to LPA.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the child sustained the infection at the child care home; therefore, the complaint allegation is unsubstantiated.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted and a copy of this report was provided to Licensee, Maria Hernandez.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4