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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334841590
Report Date: 10/20/2021
Date Signed: 10/20/2021 04:08:28 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
08/11/2021 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210811114313
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
334841590
ADMINISTRATOR:LOPEZ, ROSARIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 722-7920
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:14CENSUS: 7DATE:
10/20/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yesenia 'Rosario' LopezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee did not provide adequate supervision to daycare children.
INVESTIGATION FINDINGS:
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On 10/20/2021 at 2PM, Licensing Program Analyst (LPA) Giselle Carbullido conducted an unannounced visit to deliver the findings for the above allegations. LPA Timeka Reed conducted an initial visit on 08/20/2021, at which time a complete tour of the facility was conducted inside and out. A review of records was completed along with gathering documents. In addition to the initial visit, other outside agency visits and interviews have been conducted, additional information obtained, and documents provided. The following information and findings have been obtained and discussed with Licensee Yesenia Lopez.

It was alleged Licensee did not provide adequate supervision to daycare children.
Licensee denied any children taking other children to the park. Children interviews revealed self-admissions to taking younger children by themselves across the street to the park.

Based on LPA nterviews conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 09-CC-20210811114313
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: 10/20/2021
NARRATIVE
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California Code of Regulations, (Title 22, Division 12 ): CCR 102417 (a) Operation of a Family Child Care Home. See LIC9099D for cited deficiency. An immediate $500.00 civil penalty has been assessed.

An exit interview was conducted, and appeal right discussed. A copy of this report, Notice of Site Visit and appeal rights were provided to Licensee. This report must be made available to the public upon request for three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
08/11/2021 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210811114313

FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
334841590
ADMINISTRATOR:LOPEZ, ROSARIOFACILITY TYPE:
810
ADDRESS:1404 PEPPER LANETELEPHONE:
(951) 722-7920
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:14CENSUS: 5DATE:
10/20/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Yesenia 'Rosario' LopezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Daycare child inappropriately photographed while in care
Daycare children dietary needs are not being met
Adults hit daycare children while in care
INVESTIGATION FINDINGS:
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On the above noted date, Licensing Program Analyst (LPA) Giselle Carbullido conducted an unannounced visit to deliver the findings for the above allegations. LPA Timeka Reed conducted an initial visit on 08/20/2021, at which time a complete tour of the facility was conducted inside and out. A review of records was completed along with gathering documents. In addition to the initial visit, other outside agency visits and interviews have been conducted, additional information obtained, and documents provided. The following information and findings have been obtained and discussed with Licensee Yesenia Lopez.

It was alleged Child inappropriately photographed while in care. Due to information provided, it is not clear if pictures were taken. Children interviews reported no one takes pictures of them in care. Staff interviews stated pictures are not taken of the children however per Licensee a video clip was taken once per Parent request and sent to the Parent who missed their child via text.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 09-CC-20210811114313
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: 10/20/2021
NARRATIVE
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It was alleged daycare children dietary needs are not being met. Per Licensee interview, accommodations have been made for parent requests for lactose free or 2% milk, no pasta products, more water, fruit and fiber. Children interviewed disclosed they have eaten omelets, sandwiches, different soups, fruit, snacks, ice cream top ramen, water and milk at the day care. Record review revealed communication via phone text between Parent and Licensee for adjusting what children eat while in care. Licensee stated no formal medical documentation has been received for dietary needs.

It was alleged adults hit daycare children while in care: It was reported children have received bruises and scratches while in care. Children and staff interviews denied children being hit or being hurt. Staff interviews also reported the little children sometimes fight but are redirected with learning to share, singing, alternative activity (tv /outside play), and problem solving - (i.e. Sharing and showing there is more than one chair to use or bike to ride). Record review revealed phone texts between Licensee and parent discussing how and when an injury was sustained.

Due to conflicting information from interviews and what was reported, LPA was unable to determine if staff hit day care child while in care; facility did not meet dietary needs; or if child was inappropriately photographed while in care. Although the allegations may have happened or is valid there is not enough preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.
An exit interview was conducted, and appeal right discussed. A copy of this report, Notice of Site Visit and appeal rights were provided to Licensee. This report must be made available to the public upon request for three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 09-CC-20210811114313
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: 10/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/21/2021
Section Cited
CCR
102417(a)
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102417(a) Operation of a Family Child Care Home(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. ... the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence.
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Licensee agrees to provide this report, and cited deficiency issued by the department to the parent(s) of children in care within 24 hours or the next time in care; this includes all newly enrolled children over the next 12 months.
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Based upon LPA interviews conducted Licensee did not provide adequate care and supervision at all times. This posed an immediate health and safety risk to children in care.
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Licensee agrees to submit proof of the signed acknowledgment(s) (LIC9224) to the department by POC due date 10/21/21. **AN IMMEDIATE CIVIL PENALTY HAS BEEN ASSESSED FOR $500.00.***
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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 SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7