376300282-10-13-2021-10-CC-SHUK-C7TVXD-20211015164924

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376300282
Report Date: 10/13/2021
Date Signed: 10/13/2021 10:10:54 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 STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2021 and conducted by Evaluator Jeanette Sanchez

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20210416102241

FACILITY NAME:	LOPEZ FAMILY CHILD CARE		FACILITY NUMBER:	376300282
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Belen Lopez		TIME COMPLETED:	10:22 AM

ALLEGATION(S):

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Day-care child sustained an injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jeanette Sanchez made an unannounced visit to the facility to deliver complaint findings. LPA conducted COVID-19 screening questions prior to entry. LPA met with Licensee Belen Lopez. The investigation consisted of observation, record review, and interviews of children and parents.

On 4/16/21, the Department received a complaint regarding a child sustaining an injury while in care of the facility; more specifically a cut to child’s finger. During the investigation, LPA was not given permission to speak to the child who had the alleged injury. Confidential interview disclosed the child had a scratch on the finger which was stated to have happened when picking oranges. Other witnesses reported that the child stated it happened by a “big knife that cut trees” and then also noted to not know how cut to finger occurred. LPA did not receive or review any report of medical treatment needed for the cut.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Jeanette Sanchez	TELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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 10-CC-20210416102241

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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LOPEZ FAMILY CHILD CARE	FACILITY NUMBER: 376300282
	VISIT DATE: 10/13/2021

NARRATIVE

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While it has been established that the child did have an injury to the finger, it cannot be determined when or how the injury occurred or that it was due to a lack of supervision. Therefore, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and the allegation is unsubstantiated.

An exit interview was conducted. The appeal rights were discussed and provided along with a copy of this report to Licensee Belen Esteban on this date. A Notice of Site Visit was posted.

SUPERVISOR'S NAME: Stephanie Hudak	TELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Jeanette Sanchez	TELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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