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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376612499
Report Date: 03/02/2023
Date Signed: 03/02/2023 10:25:02 AM

Unsubstantiated


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
01/09/2023 and conducted by Evaluator Jessica M Rubio
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20230109085238
FACILITY NAME:SARIVALAS, MISTY FAMILY CHILD CAREFACILITY NUMBER:
376612499
ADMINISTRATOR:SARIVALAS, MISTYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 630-6402
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:12CENSUS: 11DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Misty SarivalasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee hit child in care.
INVESTIGATION FINDINGS:
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On March 2, 2023 at 9:45 am, Licensing Program Analyst (LPA), Jessica Rubio arrived unannounced to the Sarivalas Family Child Care Home and met with Licensee Misty Sarivalas to discuss the investigative finding of the allegation listed above. On January 18, 2023 at 10:52 pm, LPAs Jessica Rubio and Courtnee Peebles initiated the investigation and conducted a tour and census of the family child care home. During the investigation, LPAs conducted confidential interviews with licensee (LIC), assistant (AT) and four children (C1, C2, C3, C4). LPAs also obtained documents pertinent to the investigation.

On January 9, 2023, a complaint was received alleging licensee hit child in care; specifically, that LIC hit C1 when C1 was in a highchair. Confidential interviews revealed that there was an incident when C1 stood up in the highchair and AT, afraid that C1 would fall, yelled at C1 to not do that, ran over, and pulled C1 out of the highchair.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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-20230109085238
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: SARIVALAS, MISTY FAMILY CHILD CARE
FACILITY NUMBER: 376612499
VISIT DATE: 03/02/2023
NARRATIVE
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Interviews further revealed LIC was in the kitchen at the time and when LIC heard the situation, LIC also told C1 not to do that. Two interviews with children revealed LIC and AT did not hit C1 when C1 stood up in the highchair and that LIC and AT only told C1 don’t stand in the highchair, picked C1 up and made sure C1 didn’t fall. One of those same interviews revealed LIC hit C1 on a different occasion however, could not provide any details to the alleged incident. An additional interview revealed AT hit C1 on the elbow while in the highchair and when C1 was throwing toys. The interview with C1 revealed LIC did not hit C1 but LIC screamed at C1. Both LIC and AT denied ever hitting C1 or any children.

Based on conflicting statements, the allegation that licensee hit C1 in care may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated. An exit interview was conducted and a copy of this report and appeal rights were discussed and provided to Licensee Misty Sarivalas. A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Jessica M RubioTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2