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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336300495
Report Date: 04/19/2024
Date Signed: 04/19/2024 10:41:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/29/2024 and conducted by Evaluator Gabriela Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240229104014
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
336300495
ADMINISTRATOR:LEWIS, AMANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 784-9335
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:14CENSUS: 10DATE:
04/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amanda Lewis TIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Due to lack of supervision child was injured.
Licensee is not reporting incidents to authorized representative.
Child has unexplained injuries.
INVESTIGATION FINDINGS:
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On April 19, 2024 at 7:51 am, Licensing Program Analysts (LPA), Gabriela Hernandez and Licensing Program Manager Pauline Beschorner arrived unannounced to Lewis Family Childcare (FCCH) and met with Licensee Amanda Lewis to deliver the investigative findings regarding the allegations listed above. On March 5, 2024 at 2:10 pm, LPA Jeanette Sanchez and LPA Gabriela Hernandez opened the investigation at the FCCH and conducted a census. During the investigation, LPA Gabriela Hernandez conducted interviews with Licensee, 1 current staff, 1 former staff and 5 parents (P1, P2, P3, P4, P5).

On 02/29/24, a complaint was received alleging daycare child sustained unexplained injuries while in care and due to lack of supervision child was injured; specifically, that on 02/28/24, C6 sustained unexplained scratches to their face. On 01/12/24, C6 also obtained a head wound and on 01/13/24, C6 had unexplained bruises on the legs. The complaint also alleged that Licensee is not reporting incidents to authorized representative, specifically, the licensee is not accurately reporting the incidents to the authorized representative.
Continued on next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
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 10-CC-20240229104014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LEWIS FAMILY CHILD CARE
FACILITY NUMBER: 336300495
VISIT DATE: 04/19/2024
NARRATIVE
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Regarding the allegation that due to lack of supervision child was injured and child had unexplained injuries, interviews revealed that on pick up on 02/28/24, C6 was observed with 3 scratches on their nose. Per interviews, there were 3 staff present on 02/28/24, when C6 would have likely obtained the scratches. Interviews revealed that C6 had no incidents nor any altercations with any peers that day, furthermore C6 did not cry or scream at any point of the day that would have indicated C6 got an injury. Interviews further revealed the scratches were only observed by authorized representative once C6 was picked up from the day care. Based on confidential interviews during the investigation, C6 did sustain an unexplained injury, however, it could not be determined how or when the injury occurred or if the FCCH was in violation of Title 22 regulations. Therefore, the allegation due to lack of supervision and child has unexplained injuries while in care are unsubstantiated.

Regarding the allegation that Licensee is not reporting incidents to authorized representative, authorized representative did receive a text message when C6 was injured on 01/12/2024.Confidential interviews revealed that authorized representative was told C6 was injured due to a “slip and fall over a toy.” Other confidential interviews reported C6 was “pushed by another child” and another interview reported C6 “tripped on her own and fell.” There are conflicting stories on what occurred on 01/12/2024, the allegation that license is not reporting incidents to authorized representative may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated.

An exit interview was conducted and a copy of this report and appeal rights were discussed and provided to Licensee Amanda Lewis.

A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2