304310190-4-21-2020-06-CC-RLOZ-BPQTFA-20200518144110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304310190
Report Date: 04/21/2020
Date Signed: 04/21/2020 05:24:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/04/2020 and conducted by Evaluator Eileen Corral

COMPLAINT CONTROL NUMBER: 06-CC-20200204160849

FACILITY NAME:	LOPEZ, ROSA MARGARITA		FACILITY NUMBER:	304310190
ADMINISTRATOR:	LOPEZ, ROSA MARGARITA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 229-8347
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	14	CENSUS:	DATE:	04/21/2020
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:			TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Lack of Supervision
Record Keeping

INVESTIGATION FINDINGS:

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Tele-Inspection visit conducted due to COVID-19.

Licensing Program Analyst (LPA) Corral conducted a complaint investigation with the facility on today's date in response to a complaint received regarding the above allegations. This is a continuation of the investigation initiated on 02/12/2020.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the course of this investigation LPA Corral conducted interviews with the Licensee Rosa Margarita Lopez, Assistant Maria Aguirre, the Reporting Party, reviewed photographs of the injury and attempted to interview day care children.

(Continued on Page 2, 9099 C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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 06-CC-20200204160849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LOPEZ, ROSA MARGARITA	FACILITY NUMBER: 304310190
	VISIT DATE: 04/21/2020

NARRATIVE

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Page 2 (Continued LIC 9099)

On 02/04/2020 a complaint was filed with the Licensing office. The complainant stated a child sustained an injury while in care due to lack of supervision. The complainant questioned the supervision that was being provided. During the interview with the Licensee, the licensee stated she was present in the day care room with the child who fell and 2 additional children who were also playing. Licensee stated child was pushing a blue plastic cube stool (which is like a chair), child pushed cube stool but did not walk which caused her to fall face forward and hit her lip on the tile floor. Licensee stated she was present when the injury occurred and was next to the child, child fell near Licensee’s feet but was unable to reach the child before the fall occurred. Licensee stated child was given a Popsicle, and ice was applied immediately following the fall. Licensee then checked child, the child did not have any loose teeth, or show signs of pain or distress after the fall. The interview with Assistant confirmed that the Licensee was next to the child during the fall and that aide was administered after the fall.

Reporting Party also stated the Licensee failed to inform the child’s parent of the incident in a timely manner. After speaking to the Reporting Party and the Assistant it was found that the child’s parent was informed of the incident during pick up the day of the incident at approximately 1:40 PM by the Assistant. After interviewing the Licensee and Reporting Party, it was disclosed that the Licensee and the Child’s parent spoke regarding the fall the day of the incident around 8 – 9 PM.

LPA Corral also attempted to interview children during the initial 10-day visit on 02/12/2020 but the children present in care were all napping. The photographs reviewed demonstrated a child’s cut lip inside the mouth between the two front teeth. in the photographs the child’s lip was also swollen and red.

Based on the information gathered from the interviews conducted and photographs reviewed there was insufficient evidence to corroborate that the injury occurred due to lack of supervision. Although the child did fall and suffer a small injury, there is not a preponderance of evidence to prove the alleged violation did or did not occur due to lack of supervision, therefore the allegation: Lack of supervision resulting in child sustaining injury while in care is Unsubstantiated.

(Continued on Page 3, 9099 C)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20200204160849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LOPEZ, ROSA MARGARITA	FACILITY NUMBER: 304310190
	VISIT DATE: 04/21/2020

NARRATIVE

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Page 3 (Continued LIC 9099)

Based on the information gathered from the interviews conducted with Licensee, Assistant and Reporting Party there was insufficient evidence to corroborate that the Licensee failed to inform child's parent of incident. Interviews revealed that Child’s parent spoke to Assistant Maria Aguirre during pick up the day of the incident. The Child’s parent also received a call from Licensee the night of the incident. There is not a preponderance of evidence to prove the alleged reporting violation did or did not occur, therefore the allegation: Licensee failed to inform child’s parent of unusual incident in a time manner is Unsubstantiated.

Exit interview was conducted with Licensee via Tele-Inspection. Report was read and translated to Licensee in Spanish. A copy of the report along with Appeal Rights will be email to Licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available.

End of Report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

LIC9099 (FAS) - (06/04)

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