198019972-12-4-2019-33-CC-CGUA-BL9NQ5-20200128093923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019972
Report Date: 12/04/2019
Date Signed: 12/04/2019 03:39:33 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
11/26/2019 and conducted by Evaluator Betty Bell

COMPLAINT CONTROL NUMBER: 33-CC-20191126123834

FACILITY NAME:	ADAME VARGAS FAMILY CHILD CARE		FACILITY NUMBER:	198019972
ADMINISTRATOR:	MARISOL ADAME VARGAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 905-3074
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	14	CENSUS: 5	DATE:	12/04/2019
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Licensee Marisol Adame Vargas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Provider not providing safe, healthful, and comfortable accommodations

Provider operating out of ratio

INVESTIGATION FINDINGS:

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**************************************Spanish speaking LPA preferred************************************************

An unannounced initial inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell. Upon arrival, LPA was greeted and let into the residence by Licensee Marisol Adame Vargas. Though Licensee's primary language is Spanish, she stated that she understands a bit of English and that her spouse speaks a little English. The purpose of the inspection was announced to Licensee.

Upon LPA's arrival, Licensee and Adult #3 were with five children: three infants, a 2 year old and a 5 year old. At 12:00, one of the infants left and Adult #2 arrived. At 1:30 P.M., another infant left. From 1:50-2:10, Licensee went to pick up children. At 2:10, Licensee arrived with two more children. Staff-child ratio was met.

During today's inspection, interviews were conducted with three adults and documentation in the form of the Provider's Copy of the "Review Form" was obtained. In addition, seven children's files were reviewed.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

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 4

Control Number 33-CC-20191126123834

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: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
	VISIT DATE: 12/04/2019

NARRATIVE

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-Pertaining to the allegataion that "Provider not providing safe, healthful, and comfortable accommodations":

Upon LPA's arrival, LPA immediately observed two infants and one 2 year old in high chairs and an infant in a swing. One of the infants and one of the 2 year olds had one toy each on the tray in front of them; the other infant did not have anything on the tray in front of them. When asked how long the children had been in the high chairs and in the swing, Licensee stated 15-20 minutes. Licensee then stated that the children had just finished eating when LPA arrived. However, LPA did not observe any food or dishes in the dining room or in the kitchen. LPA immediately had Licensee remove the children from the high chairs and the swing. Licensee's spouse tried to put the infant who had been in the swing in the playpen (play yard,) but LPA explained that is only for use when a child is napping. Licensee explained that she does not want the infant to be on the floor because the living room floor does not have carpet and so she puts the infant in the swing, the play pen or holds the infant.

This agency has investigated the complaint alleging that "Provider not providing safe, healthful, and comfortable accommodations." Based upon the evidence as listed above, the preponderance of evidence standard has been met and the allegation has been determined to be Substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102423 "Personal Rights" is being cited on the attached LIC 9099D.

-Pertaining to the allegation that "Provider operating out of ratio":

the allegation pertains to 11/26/19 when Licensee was alone and had eight children in care, four infants and four school-aged children. This was documented by Adult #1 and Licensee admitted

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 33-CC-20191126123834

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: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
	VISIT DATE: 12/04/2019

NARRATIVE

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to this. As the regulation states that when more then six children are in care, no more than two infants can be cared for without an additional adult attendant, Licensee was thus out of ratio by two infants.

This agency has investigated the complaint alleging that "Provider "Provider operating out of ratio." Based upon the evidence as listed above, the preponderance of evidence standard has been met and the allegation has been determined to be Substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 102416.5 "Staffing Ratio and Capacity" is being cited on the attached LIC 9099D.

Please refer to 9099D for documentation of deficiencies.

Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next twelve (12) months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Licensee Maria Adame Vargas. Appeal Rights have been provided and explained to same. Upon her arrival, Assistant Danessa Melendez assisted with translation.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 33-CC-20191126123834

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: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/05/2019 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	PERSONAL RIGHTS Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.	1 2 3 4 5 6 7	Licensee agreed to purchase more inside chairs, one playpen and mats for the chldren to sleep on. In addition, Licensee will write a statement explaining that she understands the proper use of equipment.
	8 9 10 11 12 13 14	-This requirement is not met as evidenced by: upon LPA"s arrival, LPA observed three children in high chairs and one in a swing. Licensee stated they had been confined for 15-20 minutes. This poses an immediate risk to the health and safety of the children in care,	8 9 10 11 12 13 14
Type A 12/05/2019 Section Cited CCR 102416.5(b)(3)(b)	1 2 3 4 5 6 7	STAFFING RATIO AND CAPACITY A small family day care home may provide care for more than six and up to eight children, without an additional adult attendant, if all of the following conditions are met: No more than two infants are cared for during any time when more than six children are cared for.	1 2 3 4 5 6 7	Licensee showed LPA that she has a copy of the rules for ratio. Licensee will write a statement explaining that she now understands ratio and how it changes when she has an assistant present as opposed to when she is alone.
	8 9 10 11 12 13 14	-This requirement is not met as evidenced by: Licensee admited to being alone with 8 children in care, including four infants, on 11/26/19. This poses an immediate risk to the health and safety of the children in care,	8 9 10 11 12 13 14

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: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019

LIC9099 (FAS) - (06/04)

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