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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376613972
Report Date: 04/27/2020
Date Signed: 04/28/2020 03:15:26 PM



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
02/25/2020 and conducted by Evaluator Otsanya Cameron
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20200225110920
FACILITY NAME:MAYER, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376613972
ADMINISTRATOR:MAYER, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 419-0166
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:14CENSUS: 2DATE:
04/27/2020
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Teresa MayerTIME COMPLETED:
05:11 PM
ALLEGATION(S):
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Child sustained unexplained bruising while in care
INVESTIGATION FINDINGS:
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 Licensing Program Analysts (LPA) Otsanya Cameron conducted a Tele-insection using Whatsapp, for the purpose of delivering the findings for the above allegations. LPA met with Licensee Teresa Mayer, who confirmed a census of 2 children in care.

During an initial 10-day complaint investigation conducted on 3/2/2020, LPA reviewed and retrieved facility records to include, facility's child care roster and complete files for children #1-#4

The allegations state there Child sustained unexplained bruising while in care.

LPA requested documentation/an Unusual incident report that can identify any injuries/brusing, however there are no reports recorded or documented. Interviews revealed that a child had multiple bruises, but it is unclear as to where bruises came from.
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2020
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-20200225110920
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: MAYER, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376613972
VISIT DATE: 04/27/2020
NARRATIVE
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There was one incident where a child had bruising to the forehead, that was brought to the attention of the licensee by a parent of a child in care, However the licensee stated children were playing with Frisbies which accidentally hit child#1 and bruising appeared after the child had gone home. The parent later sent a picture of this to the licensee, the provider then explained the injury and how it occurred to the best of her knowledge to the parent, therefore there were no unexplained injuries or bruising.

Based on interviews and the information gathered during the investigation, the above complaint allegations are considered UNSUBSTANTIATED. No deficiencies are cited. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2