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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384001977
Report Date: 11/14/2022
Date Signed: 12/21/2022 03:38:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2022 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20221110100056
FACILITY NAME:SANCHEZ, MIRNA D.FACILITY NUMBER:
384001977
ADMINISTRATOR:SANCHEZ, MIRNA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 641-8426
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:14CENSUS: 4DATE:
11/14/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mirna SanchezTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Child sustained injuries from licensee's dog while in care.
Licensee refused to seek emergency medical care for child in care.
INVESTIGATION FINDINGS:
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(THIS IS AN AMENDED REPORT FOR COMPLAINT INSPECTION CONDUCTED ON 11/14/2022)

On 11/14/2022 at 8:30AM., Licensing Program Analyst (LPA) Luis J. Gomez met with Licensee, Mirna Sanchez. Purpose of inspection was explained and was for an unannounced, 10-day complaint inspection. Present was the licensee and licensee's daughter/ helper supervising four children (1 preschool age, 3 infant age). LPA inspected facility, inside and outside, for health and safety hazards.

During today’s inspection, LPA conducted record review, interviewed licensee, staff and performed site observations.

During the course of this investigation, site observations were conducted on 11/14/2022. A review of the facility records was also complete, which included the children’s files and staff files. LPA conducted interviews with licensee, helper and involved parties.
(REFER TO 9099C FOR CONT.)

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
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 4
Control Number 05-CC-20221110100056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
VISIT DATE: 11/14/2022
NARRATIVE
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(THIS IS AN AMENDED REPORT FOR COMPLAINT INSPECTION CONDUCTED ON 11/14/2022)
(PAGE 2)
Based on interviews and evidence collected, LPA confirmed child sustained injuries from licensee's dog while in care. Per licensee, day-care child’s sustained injury while in the hallway area.

Based on interviews, LPA confirmed, licensee did not to seek emergency medical care for child. Per licensee, after injury day-care child’s authorized representatives were informed.

Based on information obtained, the preponderance of evidence standard has been met, therefore the allegation(s) are found to be SUBSTANTIATED. California code of Regulations (Title 22, Section 12 Chapter 1) are being cited on attached 9099D. Appeal Rights were provided to the facility.

Type “A” violations were issued today. Facility is advised to provide a copy of the Evaluation Report and the Type “A” Deficiencies cited, to the parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months. A signed and dated LIC 9224 (Deficiency and Acknowledgment of Receipt of Licensing Reports) shall be maintained in all Children's files.



This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and rights to comment and appeal were discussed.

Signed copy of this report was provided to the licensee.

SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 05-CC-20221110100056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2022
Section Cited
HSC
1597.58(c)(1)
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1597.58(c)(1) Civil penalties; regulations setting forth appeal procedures for deficiencies: (1) Any violation that the department determines resulted in the injury or illness of a child. This requirement is not met as evidenced by:
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Non-Compliance Conference will be scheduled at the San Bruno Childcare Regional Office at a late date.

Civil Penalty of $500.00 was issued.
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Based on interviews and evidence collected, LPA confirmed child sustained injury from licensee's dog while in care. This poses an immediate health and safety risk to children in care.
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Authorized Representatives will sign the LIC9224, 'Notice of A-Type deficiency' by the due date: 11/20/2022.

Proof of correction will be submitted to the Department via email.
Type A
11/21/2022
Section Cited
CCR
102423(a)(2)
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102423(a)(2) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment. This requirement is not met as evidenced by:
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Non-Compliance Conference will be scheduled at the San Bruno Childcare Regional Office at a late date.
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Based on interviews, LPA confirmed, licensee did not to seek emergency medical care for child. This poses an immediate health and safety risk to children in care.
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Authorized Representatives will sign the LIC9224, 'Notice of A-Type deficiency' by the due date: 11/20/2022.

Proof of correction will be submitted to the Department via email.
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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 05-CC-20221110100056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANCHEZ, MIRNA D.
FACILITY NUMBER: 384001977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
CCR
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B-TYPE DEFICIENCY HAS BEEN REMOVED.
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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: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4