426210510-10-23-2020-17-CC-ATOO-BUVVUR-20201030164506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 426210510
Report Date: 10/22/2020
Date Signed: 10/23/2020 11:45:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2020 and conducted by Evaluator Sylvia Mendoza-Ceja

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20200807120053

FACILITY NAME:	PEREZ FCC AKA LITTLE BLESSINGS		FACILITY NUMBER:	426210510
ADMINISTRATOR:	ANA PEREZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 588-7277
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 7	DATE:	10/22/2020
		UNANNOUNCED	TIME BEGAN:	03:52 PM
MET WITH:	Ana Perez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Lack of Care and Supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an unannounced tele-inspection due to COVID - 19 State of Emergency. LPA confirmed wth with licensee Ana Perez she has video capabilities using Facetime in order to conclude the complaint investigation following the guidelines of COVID -19 and Department of Public Health (DPH) guidelines of social distancing, The complaint was initiated on 08/14/2020. The investigation included obtaining the child care roster, obtaining complainant's statement, interviewing Licensee, and parents of children in care.

Complainant stated there was a lack of care and supervision when child #1 sustained an injury in the day care.

Licensee stated child #1 was jumping alone in the bounce house and started bouncing aggressively and jumped from one end of the bounce house to the other causing the bounce house to slide which resulted in child #1 hitting is head on an umbrella pole. Licensee stated she immediately stepped in and

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2020

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 17-CC-20200807120053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEREZ FCC AKA LITTLE BLESSINGS	FACILITY NUMBER: 426210510
	VISIT DATE: 10/22/2020

NARRATIVE

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checked child #1 for injury and observed child #1 to have a bump on the left side of the forehead below the hairline, then provided first aid and applied ice to the injury. Licensee stated she then contacted parent #1 of child #1's injury. Licensee stated parent #1 requested licensee to contact parent #2 of the incident.

Interview with parent of child #1 revealed child #1 did not receive medical attention for the injury.
LPA interviewed 6 families/parents of children in care who indicated they have been notified of injuries. Parents also stated there children have not had any unexplained injuries while their children have been in care.

The above allegation is unsubstantiated, based on LPA's interviews with Licensee, complainant, parents, and record review. Although these allegations may have occurred, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore, the allegation is unsubstantiated.

An exit interview was conducted with Licensee. This report will be sent to the Licensee via email with a read receipt for confirmation of receipt of the email, Licensee shall sign and return via email to LPA S. Mendoza-Ceja.

Licensee shall post the "Notice of Site Visit for 30 days".

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja	TELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2020

LIC9099 (FAS) - (06/04)

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