<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197413473
Report Date: 02/16/2023
Date Signed: 02/16/2023 05:47:32 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/10/2022 and conducted by Evaluator Justeene Tamayo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20221010151946
FACILITY NAME:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197413473
ADMINISTRATOR:VAZQUEZ, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 722-0946
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 3DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
04:56 PM
MET WITH:Patricia Vazquez, LicenseeTIME COMPLETED:
06:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegations:

Neglect/Lack of Supervision: On or about 10/05/22, infant #1 sustained a hand injury, which resulted of skin tears on his left hand and wrist.

Reporting requirements: Licensee failed to notify the department concerning the incident within the required time frame.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/16/23, Licensing Program Analyst (LPA) Justeene Tamayo and Licensing Program Manager(LPM) Mariela Ramon met with licensee Patricia Vazquez for the purpose of concluding the investigation concerning the above complaint allegations. LPA and LPM toured the facility and observed 3 preschool children in care, along with staff #1.

This complaint was investigated by Investigator Douglas Real from the Investigation Bureau.The investigation consisted of interviews with staff, children, and other complaint relevant parties including the review of supportive documentation by law enforcement. On or about 10/05/22, around 3:30PM to 4 PM, staff #1 left infant #1 in the childcare room while staff #1 went into the kitchen to unpackage cupcakes. When staff #1 came back into the day care room, she observed infant #1 hand was stuck in a toy truck and was unable to remove it. As staff #1 removed his hand from the toy truck, infant #1 sustained a scraping injury to his left hand and wrist. Based on the evidence obtained, there is sufficient evidence to substantiated the allegation of lack of care and supervision resulting in infant #1 hand injury. A finding of substantiated means that allegation is valid.

Please see LIC9099-C for more information.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
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 4
Control Number 12-CC-20221010151946
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413473
VISIT DATE: 02/16/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
This poses an immediate risk to children in care and results in a Type A citation Neglect/Lack of Supervision. Please see LIC9099-D. An immediate civil penalty of $500 will be assessed as a result of the infant’s injury.

Interviews also revealed staff #1 did not notify the licensee nor the Department of this incident. Therefore the allegation of Reporting Requirements is substantiated. Facility has been cited a Type B Citation for Reporting Requirements 102416(a). Please see LIC 90999-D.

Upon receipt of a Type A deficiency, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

An exit interview was conducted, a copy of this report, appeal rights and notice of site visit was read and provided to licensee.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 12-CC-20221010151946
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
02/16/2023
Section Cited
CCR
102416(a)
1
2
3
4
5
6
7
Reporting Requirements 102416(a): The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee shall submit the LIC624B to LPA Tamayo no later than 02/17/23.
8
9
10
11
12
13
14
On or about 10/05/22, infant #1 sustained a scraping injury to his left hand and wrist, and Staff #1 failed to notify CCLD of the injury, which results in a potential risk to 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 12-CC-20221010151946
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
02/16/2023
Section Cited
CCR
102417(a):
1
2
3
4
5
6
7
Operation of a Family Child Care Home 102417(a): The licensee shall be present in the home and shall ensure that children in care are supervised at all times.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee shall ensure proper supevision is being provided to prevent this type of incident reoccuring. Licensee will submit a plan of how she will accomplish this no later than 02/17/23. In addition, Licensee and staff #1 shall complete training on Infant and Toddler Health and Safety, a two hour course from Small Horizons and submit a copy of completed training no later than 02/24/23.
8
9
10
11
12
13
14
Staff #1 failed to supervise infant #1 at all times, which resulted in a scraping injury to infant #1 left hand and wrist which poses an immediate risk to 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4