493009784-2-21-2020-01-CC-AHON-BMBLUC-20200302080340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 493009784
Report Date: 02/21/2020
Date Signed: 02/21/2020 04:10:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2019 and conducted by Evaluator Leticia Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20191206104645

FACILITY NAME:	ARANGO-VELEZ, MARIA FCCH		FACILITY NUMBER:	493009784
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	02/21/2020
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Maria Arango-Velez		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Child received unexplained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Leticia Rosales-Meza made a subsequent complaint investigation inspection, for the purpose of delivering complaint findings, and met with the Licensee. It has been alleged that a child received unexplained injury while in care, specifically, that on 12/5/19, Child 1 (C1) had redness and a bruise under C1's eye, and that C1 also a bad diaper rash. During the initial investigation inspection to the facility on 12/13/19, LPA discussed the allegation. The Licensee denied the allegation. The Licensee stated that on 11/14/19 at 8:40 AM, C1 did slightly fall and hit it's his nose, and it started bleeding a bit. Licensee stated that C1 did not hit it's nose very hard, there were no marks. Licensee stated that C1 constantly had it's nostrils very dry and nose bled at times. Licensee stated that she notified C1's parent and made a "My Ouch Report" the same day, and parent signed it. Licensee provided LPA with a copy of the "My Ouch Report". Licensee stated she didn't recall any other unexplained injury. Licensee stated that on one occasion C1 returned to her day care with a real bad diaper rash. Licensee stated that she questioned the parent why child had a bad rash. Licensee stated that the diaper rash did not happen while in her care because she always changes the infants

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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 01-CC-20191206104645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: ARANGO-VELEZ, MARIA FCCH	FACILITY NUMBER: 493009784
	VISIT DATE: 02/21/2020

NARRATIVE

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diapers often, even if they do not have a wet diaper. Licensee stated that she would also change all infant's clothing so they would be comfortable. Interviews were conducted with the Licensee on 12/13/19 at 2:30 PM, and Adult 1 (A1) on 2/12/20 at 1:50 PM. During the site inspections to the facility, LPA observed Licensee attending to all of the infant's needs.

Based on the information gathered during this investigation, there is insufficient information to prove or disprove the allegation as reported at this time. The allegation is determined to be Unsubstantiated.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection. This report was reviewed and discussed with the Licensee. Appeal Rights were provided.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC9099 (FAS) - (06/04)

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