304313196-1-31-2020-06-CC-BMAS-BLNVDQ-20200210152105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313196
Report Date: 01/31/2020
Date Signed: 01/31/2020 10:58:10 AM

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
11/05/2019 and conducted by Evaluator Sherene Hawkins

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20191105110857

FACILITY NAME:	GUTIERREZ, SUSAN		FACILITY NUMBER:	304313196
ADMINISTRATOR:	GUTIERREZ, SUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 719-3115
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	14	CENSUS: 5	DATE:	01/31/2020
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Susan Gutierrez		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Day care child sustained unexplained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hawkins conducted a follow up investigation and provided findings regarding the above complaint allegation which was initiated on 11/13/19. LPA met with licensee Susan Gutierrez. Present in the home was her spouse Albert Gutierrez, two adult assistants, and 4 minor children. The overall census observed was 3 adults caring for 5 children (2 infants, 1 preschooler, 2 school age). 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.

The Department received a complaint alleging lack of supervision resulting in a day care child who sustained injury while in care. During the investigation, LPA interviewed five children and four adults regarding the allegations, and reviewed pertinent documents. Although multiple attempts were made, LPA was unable to interview the victim regarding the allegation and child is no longer enrolled in the day care. It was reported that a child in care sustained a neck injury which resulted in the child receiving medical attention. Child was diagnosed with a sprained neck. **continued on page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

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-20191105110857

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: GUTIERREZ, SUSAN	FACILITY NUMBER: 304313196
	VISIT DATE: 01/31/2020

NARRATIVE

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It was reported that Child #2 (C2) aggressively grabbed Child #1 (C1), flipped him and slammed him onto the jumper. Licensee and assistants denied the allegation. Staff # (S2) who stated she was present in the jumper providing supervision of the children, reports there were no children play fighting. It was added that the children including C1 was flipping in the jumper, they were asked to stop, and S2 concluded that maybe child could have injured himself at that time but no injury or complaint from child was ever received. Licensee stated that parent reported that child complained of injury to her the following day and that’s how licensee was made aware of the injury.

Children interviewed reported that they played in the jumper, but fighting was not allowed. Another child reported that he witnessed C1 flipping in the jumper and believed C1 did hurt his neck while flipping. It was added that C1 rested and believes his parent was informed but wasn’t sure.

Based on conflicting statements received during the investigation and interviews, the allegation of a day care child sustaining unexplained injury while in care is determined to be unsubstantiated. While the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview was conducted. Notice of Site Visit was posted during the visit. 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.

Copies of LIC 811 confidential names list dated 1/31/20 was provided.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

LIC9099 (FAS) - (06/04)

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