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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 243809958
Report Date: 11/13/2019
Date Signed: 11/13/2019 12:04:28 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/29/2019 and conducted by Evaluator Joseph Pacheco
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190829163509
FACILITY NAME:GOMEZ, BERTHA FCCFACILITY NUMBER:
243809958
ADMINISTRATOR:GOMEZ, BERTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 382-2612
CITY:PLANADASTATE: CAZIP CODE:
95365
CAPACITY:14CENSUS: 5DATE:
11/13/2019
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Bertha Gomez - LicenseeTIME COMPLETED:
12:10 PM
ALLEGATION(S):
1
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9
Staff are not providing adequate supervision to daycare children.
INVESTIGATION FINDINGS:
1
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10
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13
Licensing Program Analyst (LPAs) Joseph Pacheco and Jose Penate arrived at the facility to conduct an unannounced complaint inspection to close complaint. LPAs met with Spanish speaking Licensee, Bertha Gomez, LPAs observed five day care children in the home. During the course of the investigation, LPAs conducted interviews with Licensee and parent(s) of day care children. Day care children were too young to interview. The interviews conducted revealed inconsistencies in the allegation of staff are not providing adequate supervision to daycare children. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, no deficiency is cited during today's visit.

An exit interview was conducted with Licensee, Bertha Gomez. A copy of this report was provided and discussed with Licensee. Notice of Site Visit Form was provided. Licensee understands she is to post for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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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