304313550-7-28-2021-06-CC-ECOL-C5CP2K-20210728105605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313550
Report Date: 07/28/2021
Date Signed: 07/28/2021 10:56:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	HURTADO, MARIA DEL CARMEN		FACILITY NUMBER:	304313550
ADMINISTRATOR:	HURTADO, MARIA DEL CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 654-9485
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	14	CENSUS: 4	DATE:	07/28/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Licensee - Maria Del Carmen Hurtado		TIME COMPLETED:	10:55 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Corral conducted an unannounced inspection with Licensee Maria Del Carmen Hurtado to investigate an Unusual Incident Report (UIR) which was self reported to our office on 07/20/2021. LPA Corral reviewed COVID-19 Prescreening Questionnaire prior to entering the Facility. Upon entrance to the Facility there was 1 infant and 2 preschool children having breakfast. Due to COVID 19 guidelines, LPA observed Licensee wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary on 07/27/2021 indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. According to the self-report incident, a 2 year old Child 1 (C1) was uncontrollably crying because he wanted to sit next to his sister during coloring activities outside. C1 and three siblings ages 7, 9, and 11 attended Maria's care. Licensee stated she moved the child to allow him to sit next to his sister but C1 was upset and crying. The UIR states the child threw all the pencils on the floor and threw a tantrum. Licensee stated she told the child that she would put water on his face and his head to help him get relaxed and refreshed. The UIR states that child continued to cry randomly after the tantrum. Licensee then decided to record child to show child's mother his uncontrolled behavior. The UIR states that Licensee sat next to the child and offered the child water and T.V., child then eventually stopped crying after being distracted by the T.V. According to the UIR Licensee informed C1's mother of the incident and the recording, mother did not say anything after watching the recording. The UIR states that 2-3 hours later Child's mother texted Licensee and and said they needed to talk. When mother and Licensee spoke the morning of 07/20/2021 Mother stated she should not of threatened her child by stating she was going to put water on child's face. Mother stated Licensee should have offered other methods to help child. According to the UIR Child's Mother also brought up a concern about an unclear adult living in the home. After the Licensee and Child's Mother discussion, the children left the facility with their mother. Continue to Page 2.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: HURTADO, MARIA DEL CARMEN	FACILITY NUMBER: 304313550
	VISIT DATE: 07/28/2021

NARRATIVE

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Page 2.
LPA Corral interviewed Licensee Maria Del Carmen Hurtado, Licensee confirmed what she reported on the UIR. Licensee stated Children were going to begin a coloring activity and she sat C1 next to C1's brother who is 9 years old and C1 began to cry and yell because C1 wanted to sit next to sister who is 7 years old. Licensee stated child continued to cry when she tried to move C1 next to sister. C1 then threw the colors on the ground and was upset and began to cry. Licensee stated when she approached C1, C1 cried even more. C1's brother then came to help his sibling. Licensee states C1 continued to yell, cry and be upset. At this point other children were being affected by C1's behavior, so Licensee then stated she told C1's brother she would put water on C1's hands and face to help C1 become refreshed because it was hot outside and it was about 3 PM in the afternoon. Child did not respond and Licensee stated she did not put water on the child. Licensee stated her intention was not to harm child or punish the child with water, but her intention was to help the child become relaxed and refreshed by the water because Child had been crying and it was hot. Child continued to cry, Licensee then offered the Child T.V. Licensee states Child likes Dinosaurs and she offered a Dinosaur show on the T.V., Licensee also offered the child water to drink and also offered other toys. Child did not respond to Licensee's offers and C1's behavior got worse.

Licensee stated she then decided to video record the child to show the Child's Mother how the Child was behaving. Licensee stated the child was recorded about 3 minutes. Child's brother also attempted to help the child but Child did not respond. Licensee stated Child threw himself on the floor, cried and hit siblings. Child's brother then sat with C1 to watch TV. and child slowly stopped crying and calmed down. Licensee stated about half and hour later the children went outside to play on the slide and child was calm.

The children then came inside to drink water. C1 then began to play with the Water Dispenser and C1's brother told C1 not to play with the water but C1 ignored brother. Licensee then told C1, water was not for playing but for drinking and C1 got upset and cried again for a brief time. C1's brother helped Child calm down. Licensee stated about 10 minutes later mom arrived. Licensee told mother what happened during the day and showed Mother the video recording, mother did not show concerns and left. Licensee stated about 2 hours later Mother requested for them to speak. The morning of 07/20/2021 Licensee and C1's mother spoke. Child's mother was upset about the recording and stated Licensee should have offered other methods to help Child. Licensee stated she explained to mother that she did offer child help but C1 would not respond or receive her help. Mother took children from care on 07/20/2021 and they have not returned.
Continue to Page 3.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: HURTADO, MARIA DEL CARMEN	FACILITY NUMBER: 304313550
	VISIT DATE: 07/28/2021

NARRATIVE

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Page 3.

After LPA Corral conducted Licensee interview, Assistant Liliana Algaranaz arrived with an additional preschool child. Licensee's adult daughter, Ximena Tamayo arrived shortly after.

Due to the information that was obtained by Licensee Maria Del Carmen Hurtado, no citation is being issued. Licensee offered C1 help and attempted to provide care and aide to Child during the incident. An exit interview was conducted with Licensee in Spanish. Appeal Rights were explained. The Licensee was provided a copy of Appeal Rights (LIC 9058 01/16) and 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. Licensee was informed first level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Licensee was informed Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

End of Report

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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