198020044-6-24-2019-54-CC-KHAD-BDGU5W-20190625151722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198020044
Report Date: 06/24/2019
Date Signed: 06/24/2019 10:16:37 AM

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
06/19/2019 and conducted by Evaluator Jennifer Hua

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20190619170614

FACILITY NAME:	ALVAREZ LEIVA FAMILY CHILD CARE		FACILITY NUMBER:	198020044
ADMINISTRATOR:	ALVAREZ LEIVA,S & CARLOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 448-4169
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	14	CENSUS: 2	DATE:	06/24/2019
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Leiva Alvarez		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Lack of supervision resulting in child sustaining injury while in care.

INVESTIGATION FINDINGS:

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Complaint inspection conducted by Licensing Program Analyst Jennifer Hua. LPA met with licensee, Alvarez Leiva. Assistant Maria Duenas was also present. LPA reviewed allegation with licensee. Per licensee, child #1 threw a toy and hit child #2, and child #2, reacted by scratching child #1's face. Assistant confirmed the incident and that it happened very quickly.

Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22 are being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2019

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 54-CC-20190619170614

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: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/24/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/25/2019 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,	1 2 3 4 5 6 7	Per licensee, child #1 is no longer in care. Per licensee, will respond quickly to resolve issue. Will also provide one on one supervision to ensure compliance. Licensee will also submit written statement to LPA by the POC due date of 6/25/19.
	8 9 10 11 12 13 14	healthful, and comfortable accommodations, furnishings, and equipment. The requirement is not met as evidenced by: Child #1 threw toy and hit child #2 and child #2 reacted by scratching child #1 on the face. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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) -98-3391
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2019

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20190619170614

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: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
	VISIT DATE: 06/24/2019

NARRATIVE

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An exit interview conducted with Licensee, Appeals Rights provided and explained.

Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:

1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2019

LIC9099 (FAS) - (06/04)

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