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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 393620475
Report Date: 04/16/2021
Date Signed: 04/16/2021 04:32:34 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2021 and conducted by Evaluator Fabiola Diaz
COMPLAINT CONTROL NUMBER: 53-CC-20210211155559
FACILITY NAME:VAZQUEZ, VELIA & ELIZABETHFACILITY NUMBER:
393620475
ADMINISTRATOR:VAZQUEZ, VELIA & ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 914-3805
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 7DATE:
04/16/2021
UNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Velia VazquezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Lack of Supervision- Child sustained unexplained injuries while in care.
Personal Rights- Staff not meeting diapering needs to ensure child is clean and dry at all times.
INVESTIGATION FINDINGS:
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A tele-inspection was conducted at the facility in lieu of an on-site visit, due to the recent COVID19 State of Emergency. Licensing Program Analyst (LPA) Fabiola Diaz spoke with licensee, Velia Vazquez, to deliver the findings of the complaint investigation regarding the above allegations.

Reporting Party (RP) alleged that Child 1 sustained unexplained bruises at the facility and Child 1 sustained blood in nose at the facility. RP alleged staff are not meeting the diapering needs of Child 1 and is often left wet in urine. During the investigation LPA interviewed RP, parents, staff, and the licensee. LPA obtained a children’s roster, children’s forms, and other documents. Child 1 did not receive medical attention with regards to the above allegations. Licensee stated that Child 1 never left the facility with injuries from the facility. Licensee explained that the children’s diapers are changed every 2 to 3 hours and as needed. Licensee stated that children are never left sitting in dirty diapers. Licensee stated children are supervised indoors and outdoors, and parents are informed of incidents that occur at the facility. The information acquired during the investigation did not provide the evidence to substantiate or dismiss the above allegations, therefore the above allegations were found to be unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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 53-CC-20210211155559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: VAZQUEZ, VELIA & ELIZABETH
FACILITY NUMBER: 393620475
VISIT DATE: 04/16/2021
NARRATIVE
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No deficiencies were cited at this time. An exit interview was conducted. Appeal rights and a copy of this document will be provided by e-mail to the licensee. In lieu of a signature due to COVID-19, LPA requested that the licensee acknowledge receipt of this report via e-mail or "read receipt". Licensee may provide a signed copy of the LIC 9099 if able to do so.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2