198020186-11-29-2021-33-CC-CGUA-C9BSS8-20211202130729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198020186
Report Date: 11/29/2021
Date Signed: 11/29/2021 09:54:08 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 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
06/24/2021 and conducted by Evaluator Judy Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20210624104856

FACILITY NAME:	FLORES DE RAFAEL FAMILY CHILD CARE		FACILITY NUMBER:	198020186
ADMINISTRATOR:	MARTA FLORES DE RAFAEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 979-6205
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90026
CAPACITY:	14	CENSUS: 6	DATE:	11/29/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marta Flores De Rafael		TIME COMPLETED:	10:10 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights.
Licensee's husband caused injury to day-care child.
Licensee allowed day-care children in the off-limit area.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Judy Mora conducted a complaint inspection to conclude the investigation in regards to the above complaint allegations. LPA met with Licensee, Marta Flores De Rafael, who guided LPA on a tour of the facility at approximately 9:15 AM. Visit was conducted in Spanish. Licensee's assistant, Milagro Flores, was present during this inspection. There were 6 children present. The allegation of Personal Rights was investigated by the department's Investigations Branch.

During the course of the investigation, interviews were conducted with alleged victim's parent, day care staff, Licensee's husband and day care parents. Medical reports and police incident report were obtained.

Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted with Licensee, Marta Flores De Rafael. Appeal rights provided.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021

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 1