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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370811110
Report Date: 09/03/2019
Date Signed: 09/03/2019 05:18:45 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2019 and conducted by Evaluator Selina Siao
COMPLAINT CONTROL NUMBER: 20-CC-20190827093451
FACILITY NAME:HILLER, CECILIA FAMILY DAY CAREFACILITY NUMBER:
370811110
ADMINISTRATOR:HILLER, CECILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 263-3489
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:12CENSUS: 0DATE:
09/03/2019
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Cecilia HillerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Licensee's adult grand daughter who is intellectual developmental delay hit a day care child in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Selina Siao and Gloria Gonzalez conducted an unannounced inspection for the purpose of investigating the above allegation. Upon arrival, LPAs met with licensee, her daughter/adult resident Tanya Hiller. The facility is closed for the week and no children are in care. Interviews were conducted with licensee and her daughter Tanya Hiller regarding the incident. Both licensee and her daughter admitted that the incident did happened.
Based on LPA’s interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, 102423 (a)(4) is being cited on the attached LIC 9099D.
Appeal Rights (1/16) were discussed and provided. Signature at the bottom of this report confirms receipt. Notice of Site Visit was posted during this visit and will remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
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 20-CC-20190827093451
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HILLER, CECILIA FAMILY DAY CARE
FACILITY NUMBER: 370811110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2019
Section Cited
CCR
102423(a)(4)
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Each child receiving services from a family child care home shall have certain rights.These rights include, but are not limited to, the following: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature,
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Licensee stated that she will be sure that her grand daughter will stay upstairs when children are in care to ensure that it doesn't happen again.
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including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidence by: Licensee's grand daughter who is intellectual developmental delay hit a day care child in care. This poses a potential health and safety risk to clients in care.



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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
LIC9099 (FAS) - (06/04)
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