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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566214296
Report Date: 12/27/2019
Date Signed: 12/27/2019 03:38:58 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
12/19/2019 and conducted by Evaluator Jill M Hazelhofer-Laxo
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20191219111448
FACILITY NAME:MARQUEZ FCC AKA PRESCHOOL TIME HOME CHILD DAY CAREFACILITY NUMBER:
566214296
ADMINISTRATOR:CARLA MARQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 814-5925
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY:14CENSUS: 11DATE:
12/27/2019
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Carla MarquezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff failed to provide child’s records to emergency personnel.
INVESTIGATION FINDINGS:
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On 12/27/2019 at 1:30 p.m. Licensing Program Analyst, (LPA) Jill Laxo conducted an unannounced inspection to initiate a complaint investigation. LPA met with Carla Marquez and explained the purpose of the inspection. LPA toured the family child care home. LPA observed 11 children in care. Licensee provided a current roster of children in care. LPA verified current pediatric cardiopulmonasry resuscitation card issued 12/14/2019 for licensee and assistant.

LPA's reviewed the record of C#1 and determined that the file was not complete. Licensee was unable to provide immunization records for C#1. Licensee stated the records are in the home, however licensee is unable to locate them at this time.

Based on LPAs observations and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 Chapter 1.)

The following Type "B" deficiencies is cited (refer to LIC 9099-D). The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2019
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 2
Control Number 17-CC-20191219111448
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: MARQUEZ FCC AKA PRESCHOOL TIME HOME CHILD DAY CARE
FACILITY NUMBER: 566214296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2019
Section Cited
CCR
102418(g)
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102418 Immunizations . (g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
This requirement was not met as evidenced by:
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Licensee will submit proof of immunization for C#1 to LPA Laxo by 12/30/2019.
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Based on record review the licensee failed to ensure that immunization records were filed in children files, which poses a potential Health,
Safety or Personal Rights risk to the children in
care.
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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 TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2