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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313132
Report Date: 10/07/2019
Date Signed: 10/07/2019 04:59:17 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
08/21/2019 and conducted by Evaluator Dean Valencia
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20190821143643
FACILITY NAME:CISNEROS, PATRICIAFACILITY NUMBER:
304313132
ADMINISTRATOR:CISNEROS, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 728-2122
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:14CENSUS: 1DATE:
10/07/2019
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Patricia CisnerosTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Child sustained unexplained injury while in care.
Licensee's conduct poses a risk to children in care.
Staff failed to meet child's diapering needs.
Staff speaks inappropriately to children in care.
INVESTIGATION FINDINGS:
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An inspection was made at the facility by Licensing Program Analyst (LPA) Dean Valencia to investigate the above allegations. LPA met with the licensee Patricia Cisneros. During the course of the investigation, LPA interviewed the licensee and two assistants, parents of children in care, reviewed and considered documentation related to the allegations; and conducted two separate physical plant inspections. It has been determined that from all of the available information obtained by LPA during the course of the investigation, that there is insufficient evidence indicating that the allegations occurred, or that the facility violated superivision regulations nor the children's personal rights. From the investigation conducted, there is not a preponderance of evidence to support that a child injury was sustained or unexplained while at the facility, that the conduct of the licensee poses any risk to children, that staff fail to meet the diapering needs of the children, nor speak innappropriately to children. These allegations could not be proven, but at the same time the LPA was unable to obtain any information showing that these allegations were definitively false, and proven to be unfounded. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. (continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
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 2
Control Number 06-CC-20190821143643
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: CISNEROS, PATRICIA
FACILITY NUMBER: 304313132
VISIT DATE: 10/07/2019
NARRATIVE
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An exit interview was completed. The report and findings of the complaint were reviewed and discussed with the licensee and assistants, and was provided a copy of appeal rights (LIC 9058 12/15). Their signature on this form acknowledges receipt of these rights. Notice of Site Visit was posted during the visit, and must remain posted for 30 days.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2