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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304312509
Report Date: 12/15/2022
Date Signed: 12/19/2022 07:48:46 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, 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
09/28/2022 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220928150301
FACILITY NAME:RIOS, BELINAFACILITY NUMBER:
304312509
ADMINISTRATOR:RIOS, BELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 499-7415
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:14CENSUS: 7DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Belina Rios, LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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An adult in the home discipline child inappropriately.
INVESTIGATION FINDINGS:
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On 12/15/2022, Licensing Program Analyst (LPA) Tran and Licensing Program Manager Rina Lopez conducted an in-person investigation to interview the children and deliver the finding regarding the above complaint allegation. A tour around the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 6 children and 3 staff members. A review of staff criminal clearance 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.

This a follow up complaints investigation regarding the allegation that an adult in the facility disciplined a child inappropriately.

LPA Tran conducted investigations on 09/29/2022, 10/31/2022, and on 12/15/2022.

(Continue next page)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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 5
Control Number 06-CC-20220928150301
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, BELINA
FACILITY NUMBER: 304312509
VISIT DATE: 12/15/2022
NARRATIVE
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(Page 2 of Report)

During the investigation, LPA Tran interviewed 7 children on 10/31/2022 and on 11/29/2022, and two staff on 10/31/2022 and on 12/15/2022. Five out of 7 interviewed children shared that they were in the vehicle when Adult #1 (A1) took them to the Buena Park Police Station in order to discipline Child #1 (C1). During staff interviews, Adult #1 admitted that A1 took the children by the Buena Park Police Station and assumed that A1 was providing guidance by saying if they do not behave, this is where they will end up. A1 shared that, after today 12/15/2022, A1 understood that it was a form of intimidation versus guidance.

Based on interviews with children and staff on 10/31/2022, 11/29/2022 and 12/15/2022, 5 out of the 7 interviewed children disclosed that A1 took them to the Buena Park Station to discipline C1 and A1 admitted that A1 took the children by the Buena Park Police Station and assumed that A1 was providing guidance, the preponderance of evidence standard has been met, therefore the above allegation regarding an adult in the home discipline child inappropriately,is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 12 Chapter 1, 102423 (a) (4) Personal Rights is being cited on the attached LIC 9099D.

Appeal Rights and deficiency were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeal is to Regional Manager, address is above on the report. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Belina Rios. .
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20220928150301
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, BELINA
FACILITY NUMBER: 304312509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2022
Section Cited
CCR
102423(a)(4)
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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged...(4) to be free from...intimidation, or... threat
This requirement is not met as evidenced by:
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Licensee states that she will submit a statement of understanding of the regulation and a plan to ensure all adult in the home undertand and will ensure that regulation will be followed.
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Based on interviews, 5 out of the 7 interviewed children disclosed that A1 took them to the Buena Park Station to discipline C1 and A1 admitted that the incident did occured, this posed a potential risk to the personal rights of 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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/28/2022 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220928150301

FACILITY NAME:RIOS, BELINAFACILITY NUMBER:
304312509
ADMINISTRATOR:RIOS, BELINAFACILITY TYPE:
810
ADDRESS:8151 ARTESIA BLVDTELEPHONE:
(714) 499-7415
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:14CENSUS: 7DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Belina Rios, LicenseeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Adult in the home screamed and yelled at day care children on more than one occasion
Adult in the home made inappropriate comments to day care children.
Adult in the home forced day care children to eat food.
INVESTIGATION FINDINGS:
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On 12/15/2022, Licensing Program Analyst (LPA) Tran and Licensing Program Manager (LPM) Rina Lopez conducted an in-person investigation to interview the children and deliver the finding regarding the above complaint allegation. A tour around the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 6 children and 3 staff members. A review of staff criminal clearance 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.

This a follow up complaints investigation regarding the allegation that Licensee and adult in the home screamed and yelled at day care children on more than one occasion, Licensee and adult in the home made inappropriate comments to day care children, and Licensee and adult in the home forced day care children to eat food.

LPA Tran conducted investigations on 09/29/2022, 10/31/2022, and on 12/15/2022.
(Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20220928150301
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, BELINA
FACILITY NUMBER: 304312509
VISIT DATE: 12/15/2022
NARRATIVE
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(Page 2 of Report)

During the investigation, LPA Tran interviewed 8 children on 09/29/2022, 11/29/2022 and on 12/15/2022, and on two staff on 09/29/2022 and on 10/31/2022. All interviewed children denied that they were yelled at by any staff, heard or witnessed staff made comments about their parents, or staff forced them to eat food. All interviewed staff denied that they have yelled or scream at the children, made any comments about the children's parents or forced any children to eat food; nor the have witnessed any staff did that.

Based on the interviews conducted with 8 children and 2 staff, there is insufficient evidence to corroborate the allegation that Licensee and adult in the home screamed and yelled at day care children on more than one occasion, Licensee and adult in the home made inappropriate comments to day care children, and Licensee and adult in the home forced day care children to eat food. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that facility humiliated child in front of peers did or did not occur, therefore the allegation that facility humiliated child in front of peers is UNSUBSTANTIATED.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Belina Rios.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5