434404062-3-22-2021-07-CC-MSEA-BZDL3T-20210323082427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434404062
Report Date: 03/22/2021
Date Signed: 03/22/2021 11:17:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2020 and conducted by Evaluator Elizabeth Berumen

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20201125112732

FACILITY NAME:	HERNANDEZ, MARIA		FACILITY NUMBER:	434404062
ADMINISTRATOR:	HERNANDEZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 272-7290
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95116
CAPACITY:	14	CENSUS: 7	DATE:	03/22/2021
		ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Maria Hernandez		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Licensee failed to provide adequate supervision for a daycare child

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Berumen met with Licensee, Maria Hernandez via Face Time to deliver investigation findings.
Based on inforamation gathered, LPA concludes that a day care child, left the family child care home and walked to her elementary school alone to pick up books. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC. 9099D.

This is a zero tolerance violation and accordance with the California Health and Safety Code Section 1597.58(c), you are hereby notified that an immediate $500 civil penalty is being cited. Due to the fact that the citation is an "A" violation, the Parent Notification Requirements must be followed, and the parent or authorized representative of every child must be given a copy of today's report, and a signed LIC 9224 must be kept in their child's file. For the next 12 months, the parent or authorized representative of any newly enrolled child must also be given a copy of today's report, and a signed LIC 9224 must be kept in their child's file as well.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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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Control Number 07-CC-20201125112732

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HERNANDEZ, MARIA	FACILITY NUMBER: 434404062
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/22/2021 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	Operation of a Family Child Care Home - Licensee shall be present in the home and ensure children are supervised at all times.	1 2 3 4 5 6 7	Licensee, agrees to submit a written plan of correction indicating she understands that children should be supervised at all times. A virtual informal meeting will be scheduled by management on a later date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: A day care child, left the facility unsupervised and walked to her elementary school. This presents an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	This a zero tolerance violation. An immediate 500.00 civil penalty is being accessed today. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth Berumen	TELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC9099 (FAS) - (06/04)

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