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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197492759
Report Date: 11/16/2022
Date Signed: 11/16/2022 10:47:14 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/01/2022 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20220901165035
FACILITY NAME:ESCOBAR FAMILY CHILD CAREFACILITY NUMBER:
197492759
ADMINISTRATOR:ESCOBAR, HEIDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 216-7137
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:14CENSUS: 8DATE:
11/16/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Heidy Escobar, Licensee TIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Day-care child was bit by another child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced complaint inspection to the above facility on 11/16/2022. LPA arrived at 10:05AM and met with Heidy Escobar, Licensee, who guided analyst on a tour of the facility. There were 08 children with 01 staff and Licensee upon arrival.
During the investigation LPA interviewed staff, interviewed parents, obtained a copy of the children's roster, obtained copies of supporting documentation.
Information provided by the reporting party indicates that day-care child was bit by another child in care.
Per the Licensee, this incident happened, when she was not present, due to it being pickup time and having to go pick-up other children at the school. Per Licensee, first-aid was applied to Child #1 and parents of Child#1 were notified immediately and recommended to take Child #1 to the doctor.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
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 3
Control Number 58-CC-20220901165035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ESCOBAR FAMILY CHILD CARE
FACILITY NUMBER: 197492759
VISIT DATE: 11/16/2022
NARRATIVE
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When interviewing staff, Staff #1 and #2, disclosed that the incident did occur during napping time. Staff#1 stated she they stepped out without communicating with Staff#2. When Staff#1 returned to the room, Child#2 was inside of the crib biting Child#1.
Parent #1 disclosed that Child#1 was taking taken to the doctor and was diagnosed with several biting bites around the face, leg, and back.
LPA was unable to interview Child#1 due to his their age.LPA also attempted to interview other children in care, but they were not fully verbal.

Based on LPAs observations, interviews which were conducted, photos, police report 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 102417 (a), is being cite on the attached deficiency page.

LPA explained that the deficiency is a Type A violation and requires immediate correction. Licensee was further informed of AB633 requirements. Licensee was provided with a copy of the LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled and to obtain the parent's signature on form LIC9224, as acknowledgement that they received a copy of this report. Form LIC9224 is to be retained in the child's file. Licensee was further instructed to complete this same process for all children who enroll in the facility within 12 months of this report date.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Heidy Escobar, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20220901165035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ESCOBAR FAMILY CHILD CARE
FACILITY NUMBER: 197492759
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/17/2022
Section Cited
CCR
102417(a)
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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement is not met as evidenced by: Based on LPAs observations, interviews which were conducted, photos, police report and record review, indicating that Licensee stepped out to pick up
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A declaration from Licensee was obtained “how licensee will prevent bite with children under her care and supervision”.
Licensee will provide a training
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 other children and left Child #1 and Child #2 in care with 2 staff which resulted in Child #2 biting Child #1 when not supervised.
This poses an immediatelly health & safety risk to the children in care.
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regarding Children supervision and personal right and will submit via email no later than 11/17/2022. LPA provided a copy of the form LIC9224 and Licensee will submit the form LIC9224 sign by parents to LPA’s email no later than 11/17/2022.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022
LIC9099 (FAS) - (06/04)
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