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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566209849
Report Date: 10/29/2020
Date Signed: 10/30/2020 03:18:31 PM



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
08/05/2020 and conducted by Evaluator Michael Avila
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20200805105227
FACILITY NAME:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
566209849
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/29/2020
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Lilia RoblesTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Child sustained injury while in care.
INVESTIGATION FINDINGS:
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 At 8:20 AM, Licensing Program Analyst (LPA) Michael Avila conducted an unannounced tele-inspection due to COVID19 State of Emergency. LPA informed Licensee Lilia Robles due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection will occur. LPA confirmed with license that they have video capabilities with her cell phone via Facetime to conduct the tele-inspection.
On 8/4/2020, a child sustained a head, lip and chin injury while playing in a toy-car that rolled over. The Oxnard Police Department was called to investigate the matter. Licensee stated she was in the yard with 5 children when the incident occurred. No medical attention was required for the injured child. The Oxnard Police deemed the injury was an accident and no crime was committed. LPA Avila conducted phone interviews with 4 parents who all stated Licensee always reported any injuries of their child to them.
Based on the preponderance of evidence the above allegation is found to be SUBSTANTIATED. A Technical Advisory (LIC 9102) of Regulation 102423(a)(2) - Personal Rights reminding Licensee to provide safe equipment. No deficiencies were issued during this facility tele-inspection. This report along with a copy of the appeal rights and Notice of Site Visit will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee's signature.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020
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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