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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 394500110
Report Date: 06/14/2022
Date Signed: 06/14/2022 09:38:24 AM

Substantiated


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
02/15/2022 and conducted by Evaluator Chayntel Hunter
PUBLIC
COMPLAINT CONTROL NUMBER: 53-CC-20220215140619
FACILITY NAME:QUIROZ, FELICIAFACILITY NUMBER:
394500110
ADMINISTRATOR:QUIROZ, FELICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 327-1219
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY:14CENSUS: DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Felicia QuirozTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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On 6/14/2022 the finding for the above allegation was mailed to the facility address. The Reporting Party (RP) alleged Child #1 sustained injuries on Child #1’s back while at the facility on 2/10/2022. During the investigation, Licensing Program Analyst, LPA, Katy Maestas reviewed the facility file, conducted interviews, reviewed personnel and children’s records. LPA also obtained a medical report related to Child #1’s injuries, and conducted an on-site inspection, including the back yard where day care children play on outdoor equipment including several small slides. The Department’s Investigation Branch (IB) was also referred to for assistance. During an interview the Licensee denied the allegation and stated Child #1 never got hurt at her facility. Photographs were taken of Child #1 at home during bath time on 2/9/2022 and Child #1 showed no injuries. On the morning of 2/10/2022 before Child #1 was dropped off at the facility Child #1 had no injuries. At bedtime on 2/10/2022 parent observed two abrasions on Child #1’s back. Evidence indicates a text message was exchanged between the parent and the Licensee on the evening of 2/10/22.

Report cpntinues on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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 3
Control Number 53-CC-20220215140619
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: QUIROZ, FELICIA
FACILITY NUMBER: 394500110
VISIT DATE: 06/14/2022
NARRATIVE
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When the parent asked Licensee for an explanation, she stated it sounded like Child #1 went down the slide and didn’t put their feet down and slid onto the ground. Licensee stated “they” went over to see if Child #1 was okay, and Child #1 didn’t cry. The investigation revealed that the Licensee was not home when the incident occurred. In the Licensee’s absence, she left her two assistants to provide care for the children. A medical report revealed that the injury on Child #1’s back appeared non-accidental. The LPA sought to interview the assistants, but they never returned LPA’s calls. Furthermore, during the open investigation the Licensee moved suddenly and further contact with her could not be made. LPA made multiple attempts to call the Licensee and her assistants; However, they would not return the calls.

While it could not be determined how Child #1’s back was injured, it was determined that the injury occurred while Child #1 was in care at the facility on 2/10/2022. Therefore, the allegation was substantiated. As a result, a Type A Deficiency was cited on LIC9099D. This report was mailed certified to the Licensee’s facility address. Appeal Rights were included in the report.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 53-CC-20220215140619
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: QUIROZ, FELICIA
FACILITY NUMBER: 394500110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2022
Section Cited
CCR
102423(a)(2)
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Personal Rights 102423(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived.... (2) To receive safe, healthful, and comfortable accommodations... This requirement has not been met as evidenced by:
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During the open investigation the Licensee moved suddenly before the investigation was completed. Facility is no longer operating.
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Child #1 sustained unexplained abrasions on their back while at the facility on 2/10/2022. Child #1 was taken to doctor for medical treatment. The cause of the injuries is unknown. This is an immediate health and safety risk to children in care.
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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: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3