434415847-7-27-2021-07-CC-ASTR-C7QU9W-20211012152349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415847
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:51:08 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
07/19/2021 and conducted by Evaluator Samantha Yip

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210719132353

FACILITY NAME:	AVALOS, MARIA DEL CARMEN & CERNA, JUANA		FACILITY NUMBER:	434415847
ADMINISTRATOR:	AVALOS, MARIA DEL CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 346-2243
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 10	DATE:	07/27/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maria Del Carmen Avalos and Juana Cerna		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Out of ratio

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced initial 10 day complaint investigation for the above allegation. LPA met with Licensee Maria Del Carmen Avalos and explained the reason for the inspection.

Upon arrival of inspection, LPA observed Licensee Maria Del Carmen Avalos and 10 children, whom 1 was infant age were present. Licensee Maria stated that Licensee Juana went out to run an errand. Licensee Maria called Juana during inspection and had her return. Licensee Juana arrived shortly after.

--------------------CONTINUES ON 9099 DATED 07/27/2021 PAGE 2----------------------------

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

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 4

Control Number 07-CC-20210719132353

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: AVALOS, MARIA DEL CARMEN & CERNA, JUANA	FACILITY NUMBER: 434415847
	VISIT DATE: 07/27/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

---------------------CONTINUATION OF 9099 DATED 07/27/2021 PAGE 1-----------------------

LPA discussed with Licensee Maria and Juana the capacity and ratio for a large family child care home during today's inspection. Licensees understand that there needs to be a qualified assistant with one of them at all times if they are going to have more than 8 children in care. Licensee Maria stated that she is going to be hiring an assistant and will ensure that both of them are present at all times. Based on the information obtained, the allegation listed 9099 dated 07/27/2021 page 1 is found to SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

LPA also discussed about AB 633 requirement to provided a copy of 9099 report dated 07/27/2021 and obtain a signed copy LIC 9224 for each child in care within one business day. LPA also discussed with Licensee Maria that a copy of this report and a signed copy of LIC 9224 is required for any newly enrolled children within the 12 month period. LPA will email a copy of LIC 9224 and fact sheet to Licensee Maria.

As a result of this investigation, a Type A citation has been cited. An exit interview was conducted where this report, citation, and appeals rights were discussed and provided to Licensee Maria Del Carmen Avalos. A Notice of Site Visit has been issued and must be posted for 30 consecutive days; along with a copy of the 9099 report dated 07/27/2021.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 07-CC-20210719132353

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: AVALOS, MARIA DEL CARMEN & CERNA, JUANA	FACILITY NUMBER: 434415847
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/28/2021 Section Cited CCR 102416.5(e)	1 2 3 4 5 6 7	Staffing Ratio and Capacity. If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evident by:	1 2 3 4 5 6 7	Licensee Juana Cerna arrived shortly. By POC 07/28/2021, Licensee stated that she will submit a written plan outlining how they will maintain
	8 9 10 11 12 13 14	Based on observation, LPA observed upon arrival that Licensee Maria was with 10 children, whom 1 was infant age. There was no other assistant present upon arrival. This poses an immediate risk to the health and safety to the children in care.	8 9 10 11 12 13 14	ratio at all times.
	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: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4