304312340-11-18-2022-06-CC-RLOZ-CLTMWY-20221205085907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304312340
Report Date: 11/18/2022
Date Signed: 11/18/2022 09:34:29 AM

Unsubstantiated

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
09/07/2022 and conducted by Evaluator Pat Rivas

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220907112535

FACILITY NAME:	HERNANDEZ, ESMERALDA		FACILITY NUMBER:	304312340
ADMINISTRATOR:	HERNANDEZ, ESMERALDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 486-2031
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92707
CAPACITY:	14	CENSUS: 9	DATE:	11/18/2022
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Esmeralda Hernandez, Licensee		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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lack of supervision resulting in Licensee not preventing child from hitting another child with an object resulting in injurly

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Patricia Rivas Conducted an unannounced complaint visit to render findings regarding the allegation of lack of supervision resulting in Licensee not preventing child from hitting another child with an object resulting in injurly There were 9 children present with licensee and assistnat upon arrival. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Regional Office received a complaint on 09/07/22 alleging that the licensee did not prevent a child from hitting another child with an object resulting in injury on 08/16/22. LPA Rivas conducted investigation the above allegation which included, review of records, interview with licensee and assistant, interview with parents.
Review of records show that an unusual incident report was provided by Licensee regarding incident. LPA attempted to interview children involved in incident. LPA was unable to interview Child #1(C1), no longer attended daycare and parent did not return LPA's calls. LPA attempted to interview C2 but LPA was unable to qualify child. Interview with licensee indicated that on 08/16/22 while cleaning up area to prepare for nap,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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 06-CC-20220907112535

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: HERNANDEZ, ESMERALDA	FACILITY NUMBER: 304312340
	VISIT DATE: 11/18/2022

NARRATIVE

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C1 attempted to take away a children's toy broom from C2. C2 had been sweeping area with licensee and C1 ran and grabbed broom from C2,. Both children were holding broom, Licensee told C1 to let go of broom that they will share; as C1 let go of broom, at same time C2 turned around with broom in hand and toy broom hit C1 on the head. The broom was removed by assistant and Licensee stated she immediately applied first aid to C1 and called parent.. Licensee further reported that C2 was not aware that C1 had been hit on the head. Licensee stated that incident happened in less than one minute and that C2 did not intentionally hit C1.

This agency has investigated the complaint alleging that lack of supervision resulting in Licensee not preventing child from hitting another child with an object resulting in injury. Based on information available, interviews, review of records received during the investigation, we have found that the complaint was unsubstantiated. While the allegation may have happened or is valid, there is not a preponderance of evidence to prove that an alleged violations did or did not occur.

Exit interview was conducted with Licensee Esmeralda Hernandez. in Spanish. The Notice of Site Visit was posted. Facility representative 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 were explained. A copy of their appeal rights (LIC 9058) was given and signatures on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The first level appeal is to regional manager; address is above on the report. Although the information available shows that C1 was hit with a children's broom, Licensee was present providing care

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC9099 (FAS) - (06/04)

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