334816729-1-21-2022-10-CC-SHUK-CB4SYN-20220128131747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334816729
Report Date: 01/21/2022
Date Signed: 01/21/2022 11:36:38 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2022 and conducted by Evaluator Alaina Wilburn

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20220114083227

FACILITY NAME:	DIAZ FAMILY CHILD CARE		FACILITY NUMBER:	334816729
ADMINISTRATOR:	DIAZ, MARICHEL & MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 805-2700
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	14	CENSUS: 6	DATE:	01/21/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marichel Diaz		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Day-care child was bit by a dog in the care provider's home.

INVESTIGATION FINDINGS:

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On January 21, 2022 at 9:30AM, Licensing Program Analyst (LPA) Alaina Wilburn conducted an unannounced 10 day complaint visit. LPA met with Co-Licensee Marichel Diaz, to discuss the above stated allegation.

Investigation consisted of today's visit, observation of a picture of Child #1's (C1) hand, and interviews with Co-Licensee and parent of C1.

On 01/14/2022, a complaint allegation was received by the Community Care Licensing (CCL) office that a day care child was bit by a dog in the care provider's home. Investigation revealed the following: Around 6:34pm on 01/13/2022, there were 2 children still in care and Co-Licensee Maria Diaz was in the kitchen preparing food for children. The 2 children were sitting on the living room couch waiting for the food to be finish. Marichel advised she was in the living room with the children. She went to the kitchen to check on the status of the food, and suddenly C1 walked up to her showing her the top of their hand with a small injury.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

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 10-CC-20220114083227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 334816729
	VISIT DATE: 01/21/2022

NARRATIVE

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Initially, she thought child injured their hand on the lid of the storage compartment on the couch, because C1 kept trying to play with the lid and she advised C1 not to so they wouldn't hurt themselves. While Maria Diaz was assessing and cleaning the child's hand, Marichel Diaz saw the dog run past the kitchen. After discussing the incident later with her mother and husband, they concluded the dog had followed behind the husband entering the home from the garage and got into the living room and scratched/bit the back of C1s hand.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the allegation (Day-care child was bit by a dog in the care provider's home) is found to be SUBSTANTIATED. See LIC9099D for cited deficiency. Appeal rights discussed and a copy of this report was provided to the licensee on this date.

An LIC 9224 (Acknowledgement of Receipt of Licensing Reports) was provided to Licensee during visit.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20220114083227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 334816729
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/21/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/24/2022 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights (a) Each child receiving services from a FCCH shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.	1 2 3 4 5 6 7	Licensee Marichel Diaz advised she will replace the gate that leads from the garage hallway to the living room. Ms. Diaz will submit a picture of the new gate to LPA by plan of correction date of 01/24/2022.
	8 9 10 11 12 13 14	The requirement is not met as evidenced by: On 01/13/2022, the Licensee's dog got out from the garage and bit/scratched the back of Child #1's hand, which poses an immediate health & safety risk.	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: Stephanie Hudak	TELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Alaina Wilburn	TELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022

LIC9099 (FAS) - (06/04)

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