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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434405258
Report Date: 01/07/2020
Date Signed: 01/07/2020 02:13:48 PM



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
12/30/2019 and conducted by Evaluator Janet Tse
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20191230165123
FACILITY NAME:BARRENECHEA, ISABELFACILITY NUMBER:
434405258
ADMINISTRATOR:BARRENECHEA, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 737-2813
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 10DATE:
01/07/2020
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Isabel BarrenecheaTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Medication and/or dangerous items not properly stored.
INVESTIGATION FINDINGS:
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LPA Janet Tse met with licensee Isabel Barrenechea to open investigation for the above allegation. LPA explained the nature of today's inspection to Licensee. LPA observed ten children including three infants with Licensee and her two assistants, Maria Rodriguez Velas and Luz Yanez-Mejia.

LPA obtained a copy of the roster of the children and a notification for termination of service from a parent today. LPA toured the indoor and outdoor of the home, and observed medicines on the kitchen counter, Aquafor, several Desitin creams, and diaper rash medications in one of the unlocked bathroom drawers accessible to children. LPA observed a locked storage shed in the backyard.

Based on LPA's observations, 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), are being cited on the attached LIC 9099D.

Deficiency was cited. Notice of site visit was issued and must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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 07-CC-20191230165123
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: BARRENECHEA, ISABEL
FACILITY NUMBER: 434405258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2020
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement was not met as evidenced by:
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Licensee removed the items and stored them inaccessible to children during today's inspection. Deficiency is cleared today.
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LPA observed medicines on the kitchen counter, Aquafor, several Desitin creams, and diaper rash medications in one of the unlocked bathroom drawers accessible to children.
This poses a potential risk to the Health, Safety, or Personal Rights 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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2