334844715-10-7-2022-09-CC-KWIS-CKXQ4U-20221107105052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334844715
Report Date: 10/06/2022
Date Signed: 10/07/2022 02:03:31 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, 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
09/29/2022 and conducted by Evaluator Destinee Hogue

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20220929125627

FACILITY NAME:	CORDOVA FAMILY CHILD CARE		FACILITY NUMBER:	334844715
ADMINISTRATOR:	CORDOVA,GABRIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 396-0973
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	14	CENSUS: 12	DATE:	10/06/2022
		UNANNOUNCED	TIME BEGAN:	12:52 PM
MET WITH:	Licensee Gabriela Cordova & Licensee's Spouse, Andrew Perez		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Uncleared or unassociated adults caring for daycare children

INVESTIGATION FINDINGS:

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On 10/06/2022, Licensing Program Analysts (LPAs) Destinee Hogue and Laura Mejorado arrived at the facility to conduct an investigation on the above allegation. LPAs were greeted and granted access to the facility by Licensee's Assistant, Candace Castillo. Licensee and Licensee's Spouse/Assistant, Andrew Perez arrived at the facility, at approximately 1:00pm. Present at the time of this inspection were Licensee, Licensee's Spouse, and Licensee's Assistants. LPAs conducted census and there were 12 children in care, at the time of this inspection. LPAs discussed the following with Licensee:

On an unknown date and time, it is reported that Licensee had an uncleared and unassociated adults caring for day care children. Based on interviews and record review, Adult #1 previously worked at the facility with a fingerprint status of "pending/In Process" and during this inspection, Licensee disclosed that Adult #2 resides in the home and has not been fingerprinted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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 09-CC-20220929125627

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: CORDOVA FAMILY CHILD CARE	FACILITY NUMBER: 334844715
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/07/2022 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	(d) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Immediately, Licensee agrees and understands that Adult #1 cannot be present, work, reside, or volunteer at the facility until Adult #1 receives an Eligible-Clearance or Criminal Record Exemption. Licensee agrees to have Adult #2 fingerprinted and agrees to submit a copy of LIC9163-Request for LiveScan once completed.
	8 9 10 11 12 13 14	Based on observation and record review, the licensee did not comply with the section cited above in, Adult #1 has been fingerprinted; however, fingerprints for Adult #1 are pending/"In Process" and Adult #2 resides in the home and has not been fingerprinted which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	During this inspection, Licensee wrote a statement stating Adult #1 and Adult #2 will not be present, reside, work, or volunteer in the home until Adult #1 and Adult #2 has an Eligible-Clearance or Criminal Record Exemption. CIVIL PENALTY ASSESSED DURING THIS INSPECTION.
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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: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 09-CC-20220929125627

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: CORDOVA FAMILY CHILD CARE	FACILITY NUMBER: 334844715
	VISIT DATE: 10/06/2022

NARRATIVE

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Based on the above information, the Department has determined the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

In accordance with Title 22 Regulation, 102395(a)(1) - (a) An immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed for the following: (1) Failure to obtain a California clearance or criminal record exemption, request a transfer of a criminal record clearance or request and be approved for a transfer of an exemption as specified in Section 102370(d) for any individual required to be fingerprinted under Health and Safety Code Section 1596.871 prior to allowing the individual to work, reside or volunteer in the facility.

See LIC9099D for cited deficiency. A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPAs informed Licensee Gabriela Cordova that this report dated 10/06/2022 document(s) (x1) Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPAs informed the Licensee Gabriela Cordova to provide a copy of this licensing report dated 10/06/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Gabriela Cordova.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee Hogue	TELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC9099 (FAS) - (06/04)

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