376628204-1-26-2022-20-CC-CGRY-CBPPJY-20220216102216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376628204
Report Date: 01/26/2022
Date Signed: 01/26/2022 12:55:09 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
12/02/2021 and conducted by Evaluator Dana Stevens

PUBLIC

COMPLAINT CONTROL NUMBER: 20-CC-20211202094058

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: 3	DATE:	01/26/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Mayra and Wilfredo Rodriguez		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee's conduct poses a risk to children in care.

INVESTIGATION FINDINGS:

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On 01/26/2022 at 11:30 am, Licensing Program Analyst (LPA) Dana Stevens conducted an unannounced complaint inspection to deliver findings for the above-listed allegation. Upon arrival, LPA met with licensee Mayra Rodriquez and toured the facility. There were 3 daycare children and 2 staff present at the time of the inspection.

During the investigation, interviews were conducted with Reporting party, Licensees, daycare children, daycare parents, witnesses and household members. LPA reviewed facility records and documentation from outside agencies. During interview, Licensee stated on one occasion she had backhanded Child 1(C1), a minor family member in her home, during an argument. Information obtained from confidential interviews with other parties corroborated the Licensee's statment. Based on evidence obtained during the investigation and Licensee's own statement, the above allegation is found to be substantiated.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

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-20211202094058

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: 01/26/2022

NARRATIVE

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Health and Safety Code Section 1596.885(c) is being cited. Please refer to LIC 9099-D.

Per AB633, 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. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file.

LPA reviewed and discussed this report with the Licensee and Licensee was informed she will be receiving notification to participate in a Non-Compliance Conference to develop a Compliance Plan.

An exit interview was conducted and LPA will provide a copy of this report and appeal rights (LIC 9058) and Notice of Site Visit (to be posted for 30 days).

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20211202094058

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/26/2022 Section Cited HSC 1596.885(c)	1 2 3 4 5 6 7	The department may…revoke any license…issued under this act upon any of the following grounds and in the manner provided in this act: (c) Conduct which is inimical to the health, morals… welfare, or safety of either an individual in or receiving services from the facility…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	LPA informed licensee the importance of not engaging in inappropriate behavior. LPA informed licensee the case will be reviewed by the Department’s Legal Division for potential administrative action, and a non-compliance conference will be scheduled in the near future.
	8 9 10 11 12 13 14	Based on evidence obtained during the investigation and Licensee's own statement, Licensee backhanded a minor family member during an argument, which poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	Licensee stated that she and the minor family member are currently attending family counselng sessions and learning communication tools and there have been no other occassions of arguments or altercations since the initial incident.
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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: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana Stevens	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022

LIC9099 (FAS) - (06/04)

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