364844361-12-19-2019-09-CC-KWIS-BJZRBC-20191219115229

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364844361
Report Date: 10/18/2019
Date Signed: 12/19/2019 10:39:27 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
05/28/2019 and conducted by Evaluator Carlos Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 09-CC-20190528165310

FACILITY NAME:	SALGADO FAMILY CHILD CARE		FACILITY NUMBER:	364844361
ADMINISTRATOR:	IRENE SALGADO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 633-1898
CITY:	COLTON	STATE: CA	ZIP CODE:	92324
CAPACITY:	14	CENSUS: 7	DATE:	10/18/2019
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Irene Salgado, Licensee		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Daycare child sustained a fracture while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Carlos Martinez, made a subsequent unannounced complaint investigation visit to deliver findings for the above referenced allegation. LPA met with Irene Salgado, Licensee, who was informed of the decision rendered.

LPA Martinez is delivering the findings of the complaint investigation conducted by Investigations Branch (IB) Investigator, Charlotte Jackson. Per interviews conducted, and information gathered, the investigation revealed while in care at the facility, Child #1, sustained a serious injury to the leg requiring extensive medical treatment. However, it appears to have been an accident which resulted in the injury. Investigator Jackson confirmed that the injury was consistent with a ground level fall that occurred when Child #1 stepped on a toy, which caused them to fall down. It was reported that the Licensee's assistant did not directly see the incident as it occurred but was in the area of the child. The assistant immediately went to the child's aid, and notified the Licensee who was present at the facility. The Licensee then rendered first aid to the child and contacted the child's parent, who arranged for medical treatment.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos Martinez	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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-20190528165310

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: SALGADO FAMILY CHILD CARE	FACILITY NUMBER: 364844361
	VISIT DATE: 10/18/2019

NARRATIVE

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Therefore, based on the information provided during the course of investigation, it cannot be determined whether the injury was a result of a lack of supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED, at this time.

An exit interview was conducted. A copy of this report was provided to the facility.

This report must be made available for public review for 3 years upon request.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos Martinez	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC9099 (FAS) - (06/04)

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