376611214-5-21-2020-20-CC-JGAY-BPUSXQ-20200522141620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376611214
Report Date: 05/21/2020
Date Signed: 05/21/2020 08:27:50 AM

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
02/19/2020 and conducted by Evaluator Rajani Goudreau

COMPLAINT CONTROL NUMBER: 20-CC-20200219105957

FACILITY NAME:	MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE		FACILITY NUMBER:	376611214
ADMINISTRATOR:	MAXWELL, REBECCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 419-9219
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	14	CENSUS: 0	DATE:	05/21/2020
		ANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Rebecca Maxwell		TIME COMPLETED:	08:10 AM

ALLEGATION(S):

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Licensee failed to supervise daycare child resulting in serious injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Rajani Goudreau conducted a complaint tele-inspection to deliver the finding for the above listed allegation. During the visit LPA met with licensee, Rebecca Maxwell and proceeded to virtually tour the facility. There were no children in care at time of visit. The investigation was conducted by an investigator from Community Care Licensing Division Investigations Branch. During the course of the investigation, interviews were conducted with the licensee, facility staff, daycare parents, day care children and medical records were obtained.

The Department received a complaint alleging the licensee failed to supervise a daycare child resulting in serious injuries. During the investigation it was determined, on 02/12/20, child #1 (C1) sustained multiple bruises and several abrasions to both sides of his face while in care. According to licensee, C1 was placed to sleep on an adult bed with child #2 (C2) who is a known biter and left unsupervised for an undetermined amount of time. Licensee stated C2 bit C1 multiple times causing the injuries. Based on medical records the injuries were inflicted and consistent with bite, see LIC9099-C continuation page...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020

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 20-CC-20200219105957

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: MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE	FACILITY NUMBER: 376611214
	VISIT DATE: 05/21/2020

NARRATIVE

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marks; however, medical professionals were unable to determine if a child or an adult caused the injuries. The licensee was home alone the day of the incident with no other individuals present to corroborate her explanation. Based on interviews and review of medical documentation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3, are being cited on the attached LIC 9099D).

During today’s visit facility was cited one type A deficiency, See LIC 9099-D page for cited deficiency. An exit interview was conducted with licensee. The following was discussed and will be provided to licensee via email: LIC9099, LIC9099-C, LIC9099-D page’s, appeal rights (LIC 9058), Acknowledgment of Receipt of Licensing Reports (LIC9224). LPA informed licensee upon receipt, licensee shall post licensing reports for 30 days and provide copies of current licensing reports to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months. In addition, LIC9224, must be signed by parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility and placed in each child’s record for the next 12 months. LPA informed licensee LIC9213-Notice of Site Visit shall be posted for 30 days from today’s date. COVID-19 State of emergency read receipt notification will be used in place of licensees signature.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20200219105957

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: MAXWELL, REBECCA & DANIEL FAMILY CHILD CARE	FACILITY NUMBER: 376611214
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/22/2020 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	102417-Operation of a Family Child Care Home.(a)The licensee…shall ensure that children in care are supervised at all times…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee indicated she will watch the following video titled: Children’s Personal Rights in Child Care under https//ccld.childcarevideos.org /family-child-care-providers/ and provide a summary of the video including measures to be taken to ensure the personal rights of children in care are adhered to.
	8 9 10 11 12 13 14	Based on interviews and review of medical records, licensee did not ensure C1 was supervised at all times, which poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	In addition, a non-compliance conference will be scheduled in the near future. Plan of correction is to be submitted by:05/22/20 via email to LPA, Rajani Goudreau at Rajani.Goudreau@DSS.CA.GOV.
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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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2020

LIC9099 (FAS) - (06/04)

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