274405904-6-29-2022-07-CC-MSEA-CFYHKD-20220703061543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 274405904
Report Date: 06/29/2022
Date Signed: 06/29/2022 11:52:34 AM

Substantiated

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
04/05/2022 and conducted by Evaluator Fermin Campos-Jaramillo

COMPLAINT CONTROL NUMBER: 07-CC-20220405133430

FACILITY NAME:	ROCHA, GRACIELA		FACILITY NUMBER:	274405904
ADMINISTRATOR:	ROCHA, GRACIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 633-2106
CITY:	CASTROVILLE	STATE: CA	ZIP CODE:	95012
CAPACITY:	14	CENSUS: 3	DATE:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Graciela Rocha		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Uncleared adults residing in the home.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo met with licensee Graciela Rocha and informed her the purpose of the LPA presence is to deliver the findings on the investigation for the allegations stated above. LPA observed that three children were in care today, included two infants and one preschool age. LPA observed that licensee's husband, Andres was in the home today. LPA also observed another adult, Maribel, was in the home. Licensee stated Maribel is her niece.
Based on information contained in the Salinas Police Report # 22-020819 dated on 02/21/22 which was obtained and interview with the licensee which was conducted the preponderance of evidence standard has been met, as three uncleared adults were living in the home on 2/20/22, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC. 9099D.
Civil penalties were assessed during today's inspection for the amount of $1,500.00 for individuals: Maribel Rocha, Joshua Escobedo, and Jessica Rocha.

Report dated 6/29/22 continues on page 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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 07-CC-20220405133430

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: ROCHA, GRACIELA	FACILITY NUMBER: 274405904
	VISIT DATE: 06/29/2022

NARRATIVE

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Report dated 6/29/22 continues from page 1

LPA discussed the requirements of AB 633 with the Licensee and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Licensee understands the requirements.
Licensee understands that she is required to attend an in office meeting on July 01, 2022 at 10:00 AM at the Community Care Licensing Division, San Jose Regional Office. LPA business card with the address was provided.
Appeal rights was provided to licensee Graciela Rocha, both in Spanish and in English.
Notice of Site Inspected was printed and handed to licensee and licensee was instructed to post it for 30 days.
Exit interview was conducted with licensee in Spanish.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 07-CC-20220405133430

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: ROCHA, GRACIELA	FACILITY NUMBER: 274405904
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/29/2022 Section Cited CCR 102370(d)	1 2 3 4 5 6 7	102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.	1 2 3 4 5 6 7	Licensee shall immediately deny access to the home and submit a live scan for the individuals which were found residing in the licensee’s home: Maribel Rocha, Jessica Rocha, and Joshua Escobedo. These individuals may not reside, work or be present until they obtain a criminal records clearance or exemption. In addition, licensee will submit a statement to the Community Care Licensing Department stating she understands that every adult shall first receive fingerprint clearance or exemption prior to start living or working in a family day care home.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Three of the individuals listed in the police report were found living in the home and they have not received a criminal record clearance or exemptions, as it is regulated by the CCR section cited above. Licensee understands this poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	LPA discussed the requirements of AB 633 with licensee Graciela Rocha and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) LPA explained the use and purpose of the form LIC9224 and licensee Graciela Rocha stated she understands the requirements.
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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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

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