304313602-8-17-2022-06-CC-RLOZ-CK4NVU-20221011104831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313602
Report Date: 08/17/2022
Date Signed: 08/17/2022 03:46:06 PM

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
08/10/2022 and conducted by Evaluator Mahnaz Malek

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220810151443

FACILITY NAME:	COTA, YOLANDA		FACILITY NUMBER:	304313602
ADMINISTRATOR:	COTA, YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 341-1648
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY:	14	CENSUS: 3	DATE:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Licensee and her assistant		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Licensee is operating large license without property owner/landlord notification

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an investigation regarding the above allegation. The Covid-19 Emergency Response questionnaire was reviewed and answered. LPA met with the licensee, Yolanda Cota and her assistant Yoli Piceno who were supervising 3 children of whom one was 3 years old and two others were 19 and 21 months old. LPA toured the facility with the licensee and her assistant. 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.
Our office has received an anonymous complaint regarding the above allegation. According to the report
the licensee is operating the large license capacity for 12 to 14 children without any property owner/landlord notification.
Continued on page 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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-20220810151443

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
	VISIT DATE: 08/17/2022

NARRATIVE

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Today, LPA discussed the allegation with the licensee, Yolanda Cota and her assistant, Yoli Piceno. LPA asked for a copy of the Property Owner/Landlord Notification form (LIC 9151). The licensee and her assistant looked on their file and found out LIC form was filled out for Small Family Childcare Home License for 6 to 8 children on 5/14/19. The licensee admitted that she did not fill out a form for large family childcare home license for 12 to 14 children when she changed her licensed from small capacity to large capacity in November 2020.

Based on the admission of the licensee that she did not have the form LIC 9151, the preponderance of evidence standard has been met, therefore the allegation of “Licensee is operating large license without property owner/landlord notification" is found to be SUBSTANTIATED.
California Code of Regulations, Title 22, Division & Chapter 12, Section 102417(p) is being cited on the attached LIC 9099D.

Notice of Site Visit was posted. The notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights.

Exit interview was conducted with licensee, Yolanda Cota and her assistant, Yoli Piceno.

End of report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20220810151443

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: COTA, YOLANDA	FACILITY NUMBER: 304313602
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/22/2022 Section Cited CCR 102417(p)	1 2 3 4 5 6 7	A prospective Family Child Care Home licensee who resides in a rental property shall provide written notice of intent to operate a Family Child Care Home to the landlord or owner of the rental property prior to the commencement of operation of the Family Child Care Home in accordance with	1 2 3 4 5 6 7	The licensee agreed to send a filled out copy of LIC 9151 after sending to the landlord to our office by the due date.
	8 9 10 11 12 13 14	Section 1597.40(d) of the Health and Safety Code. The licensee shall maintain proof of this notification at the Family............. This requirement was not met as evidenced by licensee's admission that she is lacking the form for changing her capacity from 8 to 14 in 2020. This is a potential hazard to the safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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