444413610-11-30-2021-07-CC-MSEA-C9BSHK-20211202125339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 444413610
Report Date: 11/30/2021
Date Signed: 11/30/2021 10:18:27 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
08/30/2021 and conducted by Evaluator Elizabeth Berumen

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20210830112009

FACILITY NAME:	COVARRUBIAS, OLIVIA		FACILITY NUMBER:	444413610
ADMINISTRATOR:	COVARRUBIAS, OLIVIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 722-8086
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	14	CENSUS: 8	DATE:	11/30/2021
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Olivia Covarrubias		TIME COMPLETED:	10:58 AM

ALLEGATION(S):

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Personal rights- Diaper changes are too long causing diaper rash
Personal rights- Staff yell at children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Elizabeth Berumen conducted an unannounced complaint visit today and met with Licensee, Olivia Covarrubias. The purpose of today's visit was to deliver the investigation findings for the above stated allegations.

During the course of the investigation, interviews were conducted.

Based on information gathered and interviews there is not enough evidence to prove that the above allegations occurred. Based on the information gathered, the allegations are UNSUBSTANTIATED. A finding that is unsubstantiated means although the allegation may have happened or are valid, the preponderance of evidence do not prove it.

No deficiencies cited. Exit interview conducted and copy of this report provided to the Licensee.

NOTICE OF SITE VISIT WAS ISSUED. LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE AREA FOR 30 DAYS.

Unsubstantiated

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: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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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