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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376626444
Report Date: 04/11/2022
Date Signed: 04/11/2022 01:02:52 PM

Unsubstantiated


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
01/26/2022 and conducted by Evaluator Casey Gulley
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20220126114904
FACILITY NAME:BECERRA, JUANA FAMILY CHILD CAREFACILITY NUMBER:
376626444
ADMINISTRATOR:JUANA BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 325-9577
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:14CENSUS: 8DATE:
04/11/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Juana BecerraTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Daycare child sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
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On 4/11/22 at 12:35 p.m., Licensing Program Analyst (LPA) Casey Gulley conducted an unannounced inspection to deliver complaint findings for the above allegation. LPA advised Licensee of the purpose of the inspection and conducted a tour of the facility. There were 8 daycare children and one staff present during the inspection.

This agency has investigated the complaint alleging that a daycare child subtained unexplained injury while in care. During the course of the investigation, interviews were conducted with multiple daycare parents, facility staff, social worker, children and licensee. Licensee denied allegation and stated C1 has a disability which causes self-inflicting harm without notice. Licensee explained prior to C1’s enrollment, Licensee was not informed by C1’s agency nor guardian of the severity of C1’s disability. Interviews with agency revealed, Licensee was not informed about the severity of C1’s disability. LPA was unable to determine if C1’s injury occurred while present at the facility or if injury was sustained due to a lack of supervision.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
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 2
Control Number 20-CC-20220126114904
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: BECERRA, JUANA FAMILY CHILD CARE
FACILITY NUMBER: 376626444
VISIT DATE: 04/11/2022
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies were 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. Exit interview conducted and report was reviewed with Licensee Juana Bercerra.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2