334844254-9-6-2019-09-CC-AROS-BGUTD9-20191011143756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334844254
Report Date: 09/06/2019
Date Signed: 09/06/2019 11:05:40 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 ST., SUITE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/26/2019 and conducted by Evaluator Blanca Ruiz-Silva

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20190726170239

FACILITY NAME:	RODRIGUEZ DE ESTRADA FAMILY CHILD CARE		FACILITY NUMBER:	334844254
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	09/06/2019
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cruz Rodriguez de Estrada		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Child received an injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Blanca Ruiz-Silva and Samuel Lopez arrived at the facility to conclude an investigation into the above allegation, a prior visit was made on 08/01/19. This inspection was conducted and explained in Spanish. On that day, LPA Ruiz-Silva met with Licensee, Cruz Rodriguez de Estrada, took census, toured the facility, reviewed records and conducted interviews with pertinent parties.

It was alleged that on or about the last week of 07/2019, Child #1 sustained an injury at the facility. Child#1 was observed by a witness with what appeared to be a blackish bruise in the soft middle part of the lower left cheek. The bruise was approximately 2” long and about ½” wide, per information obtained.

During the initial inspection on 08/01/19, LPA Blanca Ruiz-Silva observed children engaged in activities, and licensee supervising them. Interviews with children were not conducted due to the age of children and/or the children that were present at the time of the inspection did not witness the alleged incident.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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-20190726170239

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: RODRIGUEZ DE ESTRADA FAMILY CHILD CARE	FACILITY NUMBER: 334844254
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/09/2019 Section Cited CCR 102417(d)	1 2 3 4 5 6 7	102417(d) OPERATION OF A FAMILY CHILD CARE HOME. The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by: Child#1 sustained an injury at the facility while he/she used the dual child glider swing that was designed to be utilized by children of 3 to 8 years old however,	1 2 3 4 5 6 7	The licensee agrees to submit a written statement regarding the proper use of the playground equipment and that the manufacturers instructions will be followed in order to avoid any future injuries/incidents. Statement to be submitted by 09/09/19
	8 9 10 11 12 13 14	the child was less than 2 years old. Per Licensee's own admission, the Play Swing Set was not being used in a safe and consistent manner according to manufacture's instructions. This poses an immediate risk to the health and safety of the chidren 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: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20190726170239

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: RODRIGUEZ DE ESTRADA FAMILY CHILD CARE	FACILITY NUMBER: 334844254
	VISIT DATE: 09/06/2019

NARRATIVE

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The (LPA) B. Ruiz-Silva investigated the above allegation and gathered the following information: a child attended the facility, child was picked up by guardian and taken home. It was disclosed that the licensee and guardian communicated on this date as usual and discussed concerns regarding injury. Additionally, it was disclosed by licensee, Cruz Rodriguez de Estrada that on 07/26/19 at around 9:30 a.m. she took all the children in care to play in the backyard. Per licensee, Child#1 climbed on the play structure's dual child glider swing (Play structure Adventure II Play Swing Set) which is designed to be used by children between the ages of 3 to 8 years old), and fell off which resulted in the child suffering an injury on the left cheek. Licensee stated that she was unaware of any injury until later in the day when the injury became a bruise.

Based on the information obtained during the investigation and per licensee's own admission the allegation that a child suffered an injury while in care has been Substantiated.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC 9099D) CITED DURING THIS INSPECTION. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (WITHIN 24 HOURS OF THE CHILD’S NEXT DAY IN CARE) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS (AT THE TIME OF ENROLLMENT).

Appeals rights were discussed and a copy of this report was provided to the licensee on this date. The report must be made available to the public, upon request, for the next 3 years.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva	TELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC9099 (FAS) - (06/04)

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