566206919-12-22-2022-17-CC-ATOO-CQ4LWH-20230320090711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 566206919
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:46:08 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/19/2022 and conducted by Evaluator Austin Rios

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20221219153617

FACILITY NAME:	JACQUELINE ALARCON FAMILY CHILD CARE		FACILITY NUMBER:	566206919
ADMINISTRATOR:	JACQUELINE ALARCON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 512-2939
CITY:	VENTURA	STATE: CA	ZIP CODE:	93004
CAPACITY:	14	CENSUS: 6	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Jacqueline Alarcon		TIME COMPLETED:	03:56 PM

ALLEGATION(S):

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Ratio-Over Capacity

INVESTIGATION FINDINGS:

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On December 22, 2022 at 2:30 PM, Licensing Program Analyst (LPA) Austin Rios conducted an unannounced inspection to initiate a complaint investigation. LPA met with licensee Jacqueline Alarcon and explained the nature and the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were 6 children in care at the time of the inspection. The department obtained an allegation that facility is out of ratio.

Interview was conducted with licensee and licensee and licensee assistant and they confirmed verbally that on Monday 12/19/2022 the faciltiy was out of ratio because there was seventeen children here. LPA also observed the sign in sheet from 12/19/2022 that confirmed.

This agency has investigated the complaint alleging, facility is over capacity, and based on interviews conducted and documentation obtained, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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 17-CC-20221219153617

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JACQUELINE ALARCON FAMILY CHILD CARE	FACILITY NUMBER: 566206919
	VISIT DATE: 12/22/2022

NARRATIVE

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The following CCR, Title 22, Division 12 type A regulation was cited. 102416.5(d)(2) Staffing ratio and capacity.

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. LPA Rios explained and provided appeal rights to the licensee.

An exit interview was conducted with licensee

The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 17-CC-20221219153617

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JACQUELINE ALARCON FAMILY CHILD CARE	FACILITY NUMBER: 566206919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/22/2022 Section Cited CCR 102416.5(d)(2)	1 2 3 4 5 6 7	102416.2 Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home,... (2) More than twelve and up to fourteen children...	1 2 3 4 5 6 7	Licensee willl provide a written statement of how the facility will ensure that they stay in ratio by 12/29/2022 and submit to LPA via email austin.rios@dss.ca.gov or text to (805) 635-4725
	8 9 10 11 12 13 14	Interviews were conducted and sign in sheet from 12/19/2022 was observed. Licensee and assistant confirmed there was 17 children present and the sign in sheet showed 17 as well. This poses an immediate risk to the health and safety of the children in care	8 9 10 11 12 13 14
	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: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

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