304312129-11-8-2019-06-CC-RLOZ-BJALY2-20191126080938

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304312129
Report Date: 11/08/2019
Date Signed: 11/08/2019 04:44:52 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
08/28/2019 and conducted by Evaluator Thuy Ho

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190828145222

FACILITY NAME:	RIOS, HILARIA		FACILITY NUMBER:	304312129
ADMINISTRATOR:	RIOS, HILARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 530-2512
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY:	14	CENSUS: 1	DATE:	11/08/2019
		UNANNOUNCED	TIME BEGAN:	02:28 PM
MET WITH:	Licensee Hilaria Rios		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Child had access to hazardous item.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ho conducted an unannounced complaint inspection on this day. Upon arrival LPA met with licensee, Hilaria Rios and toured the facility. LPA observed 2 preschool age with 2 staff members. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the investigation LPA reviewed children's records, interviewed licensee, 1 staff member, and 2 children. LPA also reviewed documents provided by the complainant. The complainant provided credible picture showing an infant was holding a plastic bag with oranges inside. The assistant disclosed he put a bag (plastic) of oranges in the corner of the infant'splaypen to run inside the hallway to help licensee because one of the children was not listening to licensee.

(Continued on 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

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 6

Control Number 06-CC-20190828145222

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: RIOS, HILARIA	FACILITY NUMBER: 304312129
	VISIT DATE: 11/08/2019

NARRATIVE

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Based on LPA record reviews, interviews conducted, and the staff member's disclosure, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12 Chapter 3 102417(g) is being cited on the attached deficiencies page.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 06-CC-20190828145222

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: RIOS, HILARIA	FACILITY NUMBER: 304312129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/09/2019 Section Cited CCR 102417(g)	1 2 3 4 5 6 7	Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. This requirement is not met by: Based on picture provided by complainant and staff interview. Assistant disclosed leaving a plastic bag of oranges inside the infant playpen.	1 2 3 4 5 6 7	Licensee provided LPA a written statement promising not to let any staff member put any plastic bag closed to any infant.
	8 9 10 11 12 13 14	This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

LIC9099 (FAS) - (06/04)

Page: 5 of 6

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
08/28/2019 and conducted by Evaluator Thuy Ho

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190828145222

FACILITY NAME:	RIOS, HILARIA		FACILITY NUMBER:	304312129
ADMINISTRATOR:	RIOS, HILARIA		FACILITY TYPE:	810
ADDRESS:	9881 RUSSELL AVENUE		TELEPHONE:	(714) 530-2512
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY:	14	CENSUS: 1	DATE:	11/08/2019
		UNANNOUNCED	TIME BEGAN:	02:28 PM
MET WITH:	Licensee Hilaria Rios		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Daycare child pinched other daycare child.

INVESTIGATION FINDINGS:

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********* This is An Amended Report****************

Licensing Program Analyst (LPA) Ho conducted an unannounced complaint inspection on this day. Upon arrival LPA met with licensee, Hilaria Rios and toured the facility. LPA did not observed any children in care. All day care children went home. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Allegation: Daycare child pinched other daycare child. Complainant stated on 08/27/19, a 6 month old infant had pinch marks up his arm. One day care child disclosed this was done by another infant who had to separate the two infants due to licensee not doing anything.
Interviews were conducted with licensee, assistant, complainant, and four day care children. Licensee disclosed on one occasion, licensee observed a 15 month-old infant pinched a 21 months old infant

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 06-CC-20190828145222

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: RIOS, HILARIA	FACILITY NUMBER: 304312129
	VISIT DATE: 11/08/2019

NARRATIVE

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and licensee tried to separate them to prevent them pinching each other again. LPA also interviewed 1 assistant who stated had not seeing any children pinching each other. Two of the children disclosed not seeing any children pinch each other. The other two children interviewed stated on one occasion, they observed a 15 months old infant pinched a 21 old month-old infant and licensee was sitting next to the children. No one recalled seeing the six month old infant being pinched.

Although, there was an incident where a child pinched another child, but licensee was present and witnessed the child being pinched even though she was not able to prevent the injury. Based on the information obtained through interviews conducted, there was lack of evidence to corroborate the lack of supervision or personal rights allegation.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged Day care child pinched other day care child, violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy Ho	TELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019

LIC9099 (FAS) - (06/04)

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