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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 223910193
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:00:43 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2023 and conducted by Evaluator Yesenia Fierro
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20230426131749
FACILITY NAME:MATTHEWS, ANA FAMILY CHILD CAREFACILITY NUMBER:
223910193
ADMINISTRATOR:MATTHEWS, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 966-3590
CITY:MARIPOSASTATE: CAZIP CODE:
95338
CAPACITY:14CENSUS: 10DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana MatthewsTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Unqualified staff caring and supervising day care children.
Provider does not keep day care home sanitary.
Provider does not keep day care home free of animal feces.
Provider utilizes off limit areas for napping infants.
INVESTIGATION FINDINGS:
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On 07/18/2023, Licensing Program Analyst (LPA) Yesenia Fierro and LPA Ka Vang conducted an unannounced complaint inspection. LPA met with Licensee, Ana Matthews. The purpose of the inspection was to deliver findings for the above complaint allegations.

During this investigation, LPA interviewed Licensee, reviewed documents, conducted parental interviews and conducted an inspection of the inside and outside of the home.

LPA inspected the inside of the home, during the inspection LPA observed an infant sleeping in an inaccessible room with the door closed. Licensee confirmed and acknowledged that room was inaccessible to children. LPA observed several areas in the home with boxes/items stacked up high causing a potentially safety risk. The home was cluttered, disorganized and disheveled and the outdoor play area had an unreasonable amount of dog feces.

Upon file review Staff #1 was missing several documents. Licensee confirmed that she was still collecting documentation from Staff #1 right up until Staff #1 quiet.

Based on investigation conducted and evidenced obtained, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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 3
Control Number 04-CC-20230426131749
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MATTHEWS, ANA FAMILY CHILD CARE
FACILITY NUMBER: 223910193
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
07/18/2023
Section Cited
CCR
102425(5)(A)
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(A) The provider shall be able to visually observe the infant without moving the door
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Licensee agrees to watch the How to be Licensed video "Safe Sleep" on the CCLD website and submit a 1 page paper explaining how she will implement this in her facility.
Request Denied
Type B
07/18/2023
Section Cited
CCR
103417(b)
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102417 Operation of a Family Child Care Home. (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
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Licensee agrees to watch the How to be Licensed video"Health and Safety" on the CCLD website and submit a 1 page paper explaining how she will implement this in her facility.
Request Denied
Type B
07/18/2023
Section Cited
CCR
102416.1(a)
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102416. Personnel Records (a) Personnel records shall be maintained on each employee and shall contain the following information: (1) Employee's full name…(12) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 102370(d).
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Licensee agrees to watch the How to be Licensed video "Record Keeping" on the CCLD website and submit a 1 page paper explaining how she will implement this in her facility.
Licensee also agrees to submit proof personal record staff #2
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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: Rene MancinasTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Yesenia FierroTELEPHONE: (559) 794-0709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3