334841590-2-24-2021-09-CC-GSEA-BZ2MXT-20210312090025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334841590
Report Date: 02/24/2021
Date Signed: 02/24/2021 03:08:14 PM

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 ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2021 and conducted by Evaluator Timeka Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20210111164724

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	334841590
ADMINISTRATOR:	LOPEZ, ROSARIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 722-7920
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	14	CENSUS: 4	DATE:	02/24/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Rosario Lopez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Lack of supervision resulted in child sustaining injury while in care.
Licensee failed to report injury to parent.

INVESTIGATION FINDINGS:

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Due to Covid-19 pandemic and the executive order issued by Governor Newsom on March 16, 2020, on February 5, 2021, Licensing Program Analyst (LPA) Timeka Reed delivered findings telephonically to Rosario Lopez, Licensee, for the complaint allegations initiated on January 11, 2021.
The complaint alleges a lack of supervision resulted in a child sustaining an injury while in care and Licensee failed to report injury to parent. LPA interviewed all pertinent and confidential witnesses regarding the allegation.
Interviews are consistent Child #1 (C1) and Child #2 (C2) were involved in a physical incident where C2 was pushed by C1 resulting in C2 sustaining an injury. Interviews are also consistent C1 has a history of aggressive behavior towards C2, and both the Licensee and Day Care Staff stated they are aware of C1’s history.
On the date of the incident, on or about January 5, 2021, Licensee stated she was aware C1 was upset with C2 prior to C1 pushing C2. Licensee failed to ensure the health and safety of C2 by not providing supervision of C1 and preventing C1 from making physical contact with C2.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Timeka Reed	TELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

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 09-CC-20210111164724

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 334841590
	VISIT DATE: 02/24/2021

NARRATIVE

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Evidence gathered and confidential statements indicate after being pushed by C1, C2 hit their head. C2 immediately complained to the Licensee of pain. Although the Licensee provided first aid to C2, the Licensee failed to notify the child’s authorized representative/parent an injury had occurred.
This agency investigated the complaint of a lack of supervision resulted in a child sustaining injury while in care and Licensee failed to report injury to parent. Based on interviews and the information obtained, the allegations are substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

See LIC 9099D for deficiency cited.

A copy of this report along with a notice of site visit was explained and provided to Rosario Lopez

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Timeka Reed	TELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 09-CC-20210111164724

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 334841590
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/24/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/26/2021 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights (a)(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. Based on interviews conducted and photographs, licensee failed to provide a safe environment for child in care.	1 2 3 4 5 6 7	Licensee will provide a written statement detailing how she will provide supervision to children in care that demonstrate agressive behavior. Licensee will ensure that arrangements are made to ensure that in the event she or her staff have to be absent from the home, supervision is provided at all times to C1.
	8 9 10 11 12 13 14	This poses as an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	Licensee will provide letter via the email address provided by LPA Reed.
	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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Timeka Reed	TELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 09-CC-20210111164724

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 334841590
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/24/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/26/2021 Section Cited CCR 102416.2(f)(1)	1 2 3 4 5 6 7	Reporting Responsibilities As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a). Any injury suffered by a child in care	1 2 3 4 5 6 7	Licensee will provide a written statement that she will notify parent or authorized representative that thechild in care sustained an injury. Licensee will provide letter via the email address provided by LPA Reed.
	8 9 10 11 12 13 14	shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional. Based on the interviews conducted, licensee failed to notifiy the childs parent or authorized representative of an injury. This poses as a potential health and safety risk to 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: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Timeka Reed	TELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021

LIC9099 (FAS) - (06/04)

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