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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 274404456
Report Date: 10/06/2021
Date Signed: 10/11/2021 04:33:14 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2021 and conducted by Evaluator Elizabeth Larios
COMPLAINT CONTROL NUMBER: 07-CC-20210709103302
FACILITY NAME:VASQUEZ, LAURAFACILITY NUMBER:
274404456
ADMINISTRATOR:VASQUEZ, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 261-0609
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:14CENSUS: 5DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Laura Vasquez TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee does not live at home.
Uncleared adults living in home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs), Elizabeth Larios & James Santos, conducted an unannounced complaint investigation to deliver investigation findings. LPAs met with Licensee, Laura Vasquez and explained the purpose of the inspection.

Based on observation, record reviews and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. Licensee was cited on 07/16/2021 for uncleared adults living in home.

Exit interview was conducted, where this report was reviewed and discussed with Laura Vasquez. Appeal rights were also provided. Type B deficiency was cited during today's visit.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.



Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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 2
Control Number 07-CC-20210709103302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: VASQUEZ, LAURA
FACILITY NUMBER: 274404456
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2021
Section Cited
HSC
1596.78(a)
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§1596.78 “Family day care home”(a) "Family day care home" means a home that regularly provides care, protection, and supervision for 14 or fewer children, in the provider's own home, for periods of less than 24 hours per day, while the parents or guardians are away, and is either a large family day care home or a small family day care home.
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An updated application (LIC279) form must be submitted to the licensing office by 10/13/2021. Licensee will be asked to come to CCL for a meeting.
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This requirement was not met as evidenced by: LPA became aware that the Licensee has not been residing at the home, 1078 Faulkner Street Salinas, CA 93906 where she is licensed as a large Family Child Care Home.This poses a potential risk to the children in care.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
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