376628204-3-29-2021-20-CC-JCAO-BZWKG2-20210409075247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376628204
Report Date: 03/29/2021
Date Signed: 03/29/2021 01:37:09 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
01/22/2021 and conducted by Evaluator Adrian Castellon

COMPLAINT CONTROL NUMBER: 20-CC-20210122110523

FACILITY NAME:	RODRIGUEZ, MAYRA & WILFREDO FAMILY CHILD CARE		FACILITY NUMBER:	376628204
ADMINISTRATOR:	MAYRA & WILFREDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 305-5400
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	14	CENSUS: 12	DATE:	03/29/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mayra Rodriguez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Child sustained a fracture while in care.

INVESTIGATION FINDINGS:

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On 03/29/21 at10:45am, Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced
tele-inspection to deliver complaint findings for the above allegation. Due to COVID-19 state of emergency, this inspection was conducted via teleconference. There were 12 children present. LPA Castellon met with licensees Mayra and Wilfredo Rodriguez.

It was alleged that a child (C1) sustained a fracture while in care. A full investigation was conducted by the Department’s Investigations Branch. Interviews were conducted with licensees, facility staff, daycare parents, and outside resources. Medical records were obtained and reviewed. It was determined, C1 was last in care at the facility on 01/19/21. C1 was at home on 01/20/21 and 01/21/21. C1 was seen by a physician on 01/20/21 and no injuries were identified. During a subsequent visit on 01/21/21 the injury was found. Based on the information obtained during the course of the investigation, it could not be established as to how, when or where the injury occurred. The above allegation is found to be UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. (continued on 9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

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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Control Number 20-CC-20210122110523

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: RODRIGUEZ, MAYRA & WILFREDO FAMILY CHILD CARE	FACILITY NUMBER: 376628204
	VISIT DATE: 03/29/2021

NARRATIVE

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A copy of today's report, Notice of Site Visit, and appeal rights were emailed to the licensee. An exit interview was conducted with the licensee and licensee stated that she understood. Licensees were advised acknowledgement of receipt of the report and appeal rights is to be received within twenty-four hours. COVID-19 State of emergency read receipt notification will be used in place of licensee’s signature. LPA Castellon informed licensee Notice of Site Visit shall be posted for 30 days from today’s date.

SUPERVISOR'S NAME: Joe Carrasco	TELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian Castellon	TELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

LIC9099 (FAS) - (06/04)

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