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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426214390
Report Date: 08/03/2021
Date Signed: 08/03/2021 10:44:40 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
07/27/2021 and conducted by Evaluator Sylvia Mendoza-Ceja
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20210727100010
FACILITY NAME:GASTELUM FCC AKA LITTLE LADY BUG DAYCAREFACILITY NUMBER:
426214390
ADMINISTRATOR:BLANCA GASTELUMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 455-3569
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 8DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Jamie Madrid Gastelum and Maria GastelumTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Licensee is not meeting requirements of 80% at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) S. Mendoza-Ceja and C. Patterson conducted an unannounced inspection to the home. Prior to entry to the home, a risk assessment for COVID-19 was conducted. LPAs met with licensee's adult daughter Jamie Madrid Gastelum and Maria Gastelum who were providing care for seven children. During the inspection one more child arrived.
Interview conducted with Licensee Blanca Gastelum by telephone revealed she was not in town; however, care was being provided by her daughter Jaime Madrid Gastelum and Maria Gastelum.
Interview conducted with Licensee's adult daughter Jaime Madrid Gastelum revealed Licensee Blanca Gastelum is not in the home and is out of town. Jamie Madrid Gastelum stated the last time the Licensee Blanca Gastelum was working in the day care was appriximately two weeks ago.

Based on observation and interviews, revealed the Licensee Blanca Gastelum is not available 80 percent of the time and leaves the children in care of Jaime Madird Gastelum and Maria Gastelum while she is out of town which is violation of the regulation. The following Type B deficiency is cited on page 2 according to CCR, Title 22 Division 12. An exit interview was conducted and Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 17-CC-20210727100010
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: GASTELUM FCC AKA LITTLE LADY BUG DAYCARE
FACILITY NUMBER: 426214390
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2021
Section Cited
CCR
102417(a)
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102417(a) Operation of a Family Child Care Home. When circumstances require....Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement was not met and evidenced by:
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Please submit a written plan of correction to Licensing by 08/09/2021.
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LPAs observation and interviews which revealed Licensee Blanca Gastelum is not providing care to children today and has not provided care for approximately two weeks.

This poses a potential risk to the Health and Safety of 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2