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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376619543
Report Date: 11/12/2021
Date Signed: 11/12/2021 10:01:41 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
11/05/2021 and conducted by Evaluator Nancy Diaz
COMPLAINT CONTROL NUMBER: 51-CC-20211105151847
FACILITY NAME:NEVAREZ, LOURDES & EDUARDO FAMILY CHILD CAREFACILITY NUMBER:
376619543
ADMINISTRATOR:LOURDES & EDUARDO N.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 562-0509
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:14CENSUS: 1DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Lourdes & Eduardo NevarezTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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1. Facility was not maintained free of defects or conditions which might endanger a child.
INVESTIGATION FINDINGS:
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On 11/12/21 @ 9:08AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced inspection in reference to the above allegation. LPA met and toured the house with Lourdes & Eduardo Nevarez and observed the following defects: Nails were observed sticking out of the door of barricade (at the bottom of stairs); Nails were observed sticking out of the kitchen door and broken tile at the bottom of the stairs that is sharp. LPA also observed 4 power outlets were not covered in the living room. These conditions poses an immediate risk to children in care.
Based on LPA's observation, LPA determined that the preponderance of evidence has been met. There is enough supporting information to prove the above allegation is SUBSTANTIATED, see deficiencies cited on the attached LIC 9099D. Appeal Rights (1/16) were discussed and provided. Signature on this report acknowledged receipt of licensing reports and appeal rights. Notice of site visit was provided and observed post
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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 3
Control Number 51-CC-20211105151847
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: NEVAREZ, LOURDES & EDUARDO FAMILY CHILD CARE
FACILITY NUMBER: 376619543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2021
Section Cited
CCR
102417(g)
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OPERATION OF A FAMILY CHILD CARE HOME. The home shall be free from defects or conditions which might endanger a child.
This requirement was not met as evidenced by:
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Mr. Nevarez stated that he will remove the nails that were sticking out; purchase more power outlets and cover the 4 power outlets in the living room and fix the tile at the bottom of the stairs by Monday, 11/15/21.
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Based on LPA's observation, Licensee did not maintain the home free from defects that might endanger a child. LPA observed nails sticking out of the bottom barricade and kitchen door; broken tile at the bottom of the stairs that is sharp and 4 power outlets that were not covered
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3