414004575-8-12-2021-05-CC-GLEG-C62THY-20210819144532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414004575
Report Date: 08/12/2021
Date Signed: 08/12/2021 05:11:35 PM

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
05/26/2021 and conducted by Evaluator Marie Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20210526101944

FACILITY NAME:	ESPINOZA, YADIRA		FACILITY NUMBER:	414004575
ADMINISTRATOR:	ESPINOZA, YADIRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 315-4277
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 7	DATE:	08/12/2021
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Yadira Espinoza		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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- Child sustained an unexplained injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced inspection to deliver findings and close complaint. LPA met with Licensee Yadira Espinoza and explained purpose of visit. Licensee had six children in care (two infants and one preschool child and her three minor children). A seventh child arrived shortly after LPA's arrival.

During the course of the investigation, interviews were conducted and pertinent documents and other evidence received were reviewed. Per review of outdoor video camera recording of incident in question, camera angle does not show if Child C1 got injured underneath the awning of house while playing outside. Child is seen sitting and leaning forward to get up and is heard crying in the video. Child appears to stop crying when Licensee picked child up. Child did not appear to have an injury at time of video. Per interview with Licensee, Licensee stated child didn't appear to be injured when she picked child up.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is closed as UNSUBSTANTIATED.

This report was reviewed and discussed with Licensee Yadira Espinoza. A copy of report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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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