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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845714
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:25:04 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
08/23/2021 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210823163723
FACILITY NAME:ERWIN FAMILY CHILD CAREFACILITY NUMBER:
334845714
ADMINISTRATOR:ERWIN,ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 226-7857
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY:14CENSUS: 0DATE:
08/25/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Elizabeth Erwin, LicenseeTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility is not following mask guidance for children in care.
INVESTIGATION FINDINGS:
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On 08/25/2021 at 12:45PM Licensing Program Analyst (LPA) Giselle Carbullido conducted an unannounced visit regarding a complaint received concerning the above allegation. LPA was given access to the facility by Licensee LPA discussed purpose of visit, took census and toured the facility. LPA met with Ms. Erwin to further discuss the complaint allegation(s) and deliver findings.

It was alleged the facility is not following Covid-19 guidelines for masks by staff and children.
At 1pm, LPA toured the facility and observed no children present. LPA conducted interview with Licensee. Interview revealed Licensee and Assistant are required to wear masks and children only wear masks if a parent provides them.

Based on evidence gathered and Licensee interview, the complaint allegation is substantiated, meaning the allegation is valid and the preponderance of the evidence standard has been met.
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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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 2
Control Number 09-CC-20210823163723
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: ERWIN FAMILY CHILD CARE
FACILITY NUMBER: 334845714
VISIT DATE: 08/25/2021
NARRATIVE
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LPA provided technical assistance to Licensee by reviewing and providing a copy of the current guidelines (as outlined by the California Department of Public Health) for family child care as follows:

1) California Department of Public Health
a. Guidance for Child Care Providers and Programs
Released on June 29, 2021
b. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Child-Care-Guidance.aspx#

2) California Department of Public Health


a. Guidance for Face Coverings
Released on July 28, 2021
b. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx

3) https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Face-Coverings-QA.aspx



An exit interview was conducted, and appeal rights discussed. LPA provided Licensee with a copy of this report, appeal rights and notice of site visit. A copy of 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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2