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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376626659
Report Date: 04/28/2020
Date Signed: 04/28/2020 02:20:05 PM



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
02/19/2020 and conducted by Evaluator Michelle Hood
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20200219102021
FACILITY NAME:AGUIAR, JUSTINA FAMILY CHILD CAREFACILITY NUMBER:
376626659
ADMINISTRATOR:JUSTINA AGUIARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 609-6833
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 10DATE:
04/28/2020
ANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Justina Aguiar, LicenseeTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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9
Child sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Michelle Hood conducted an announced tele-inspection to deliver complaint findings for the allegation below. LPA met with Licensee. It was alleged child sustained unexplained injury while in care. Interviews were conducted with licensee, facility staff, daycare parents (2), daycare children (2) and outside resources (2). Facility staff members interviewed did not observe bruising on the child’s right ear; however, outside resources observed child with fading bruises on the right ear. Interview with the parent revealed she believed the injury occurred at the daycare. Review of the medical record for the child reflected no information regarding the assessment of the ear or documentation of an injury to the ear. While in care at the facility child showed no visible signs of injury, nor exhibiting any other signs of distress. Based on evidence obtained, LPA was unable to determine if the injury occurred at the facility.

Due to conflicting statements obtained during the course of the investigation, the above allegation is found to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Licensee was provided appeal rights (LIC9058 01/16) and their signature on this form acknowledges receipt of these rights. Provided Notice of Site Visit. LPA observed that LIC 9213 was posted.
No deficiencies cited. An exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (619) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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