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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376616155
Report Date: 07/13/2022
Date Signed: 07/15/2022 04:14:12 PM

Substantiated


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
04/28/2022 and conducted by Evaluator David Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20220428092319
FACILITY NAME:NORIEGA, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
376616155
ADMINISTRATOR:MARTHA NORIEGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 309-8953
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:14CENSUS: 11DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Martha Noriega TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee did not properly maintain child's record
INVESTIGATION FINDINGS:
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On 07/13/2022 at 10:00 AM, Licensing program Analyst (LPA) David Miller conducted an unannounced complaint inspection to deliver the findings to the above allegation. LPA advised Licensee Martha Noriega of the inspection’s purpose. Present in the home was the Licensee, two staff members, and 11 children (1 infants, 10 children age 2-5).

It was alleged that the Licensee did not properly maintain a child's record. Interviews conducted with the reporting party, licensee, two staff members, daycare parents, and files reviewed. Licensee admitted that she allowed child #1 (See LIC811 Confidential Names) to attend the daycare without required records to include the emergency information form and consent for medical treatment. LPA conducted a facility file review and noted that the licensee did not have any records for child #1.
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, Type B deficiency is being cited on the attached LIC 9099D.




Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David MillerTELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
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 6
Control Number 20-CC-20220428092319
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: NORIEGA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376616155
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2022
Section Cited
CCR
102421(b)
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102421(b) The licensee shall maintain, in each child's record, a copy of the emergency information form and consent for medical treatment. This requirement is not met as evidenced by:

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Licensee stated she will watch Department training video regarding maintaining and ensuring a facility has all documents for children in care: https://ccld.childcarevideos.org/family-child-care-providers/record-keeping-in-family-child-care/

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Based on observation and interviews and record review the licensee did not comply with the section cited above. There are no records for child #1, which poses a potential health, safety or personal rights risk to persons in care.
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Licensee stated she will provide the Department a written statement summarizing what she viewed on the training video and a written statement on how she will ensure that all required records before enrollment to the facility. Licensee will provide LPA with this written statement no later than 07/25/2022.
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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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David MillerTELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
04/28/2022 and conducted by Evaluator David Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20220428092319

FACILITY NAME:NORIEGA, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
376616155
ADMINISTRATOR:MARTHA NORIEGAFACILITY TYPE:
810
ADDRESS:9113 AKARD STREETTELEPHONE:
(619) 309-8953
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:14CENSUS: 11DATE:
07/13/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Martha Noriega TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee is operating outside of license terms and conditions
Licensee does not provide proper supervision to children in care
Facility does not have a working telephone
INVESTIGATION FINDINGS:
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On 07/13/2022 at 10:00AM, Licensing program Analyst (LPA) David Miller conducted an unannounced complaint inspection to deliver the findings to the above allegations. LPA advised Licensee Martha Noriega of the inspection’s purpose. Present in the home was the Licensee, two staff members, and 11 children (1 infants and 10 age 2-5).

It was alleged that the Licensee is operating outside of license terms and conditions, that the licensee does not provide proper supervision to the children in care, and that the facility does not have a working telephone. Interviews conducted with the reporting party, licensee, two staff members, daycare parents and children in care. The licensee stated that she cannot recall the number of children, but denied being overcapacity. Staff stated the facility is not operating beyond the licensed capacity. The licensee and staff denied not providing proper supervision; however, child #1 (See LIC811 Confidential Names) did sustain an injury to his back from another child at the facilty.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David MillerTELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 20-CC-20220428092319
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: NORIEGA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376616155
VISIT DATE: 07/13/2022
NARRATIVE
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The licensee stated that she has a working cellphone; however, she stated that she may have accidentally placed the phone on silent and was unable to retrieve her messages. LPA dialed the phone during the inspection, and observed that licensee's phone did not ring, but did observe the phone light up.

Based on evidence obtained and due to conflicting statements, all three allegations are determined to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. A copy of this report was provided to licensee, Martha Noriega.

An exit interview was conducted and report was reviewed with the licensee Martha Noriega
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David MillerTELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 20-CC-20220428092319
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: NORIEGA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376616155
VISIT DATE: 07/13/2022
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. LPA observed the Notice of Site visit posted.

An exit interview was conducted and report was reviewed with licensee Martha Noriega.




SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: David MillerTELEPHONE: (619) 987-8901
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6