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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197495103
Report Date: 05/20/2022
Date Signed: 05/20/2022 11:25:12 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/12/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220512113341
FACILITY NAME:CASTILLO FAMILY CHILD CAREFACILITY NUMBER:
197495103
ADMINISTRATOR:IRMA CASTILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 841-0852
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:14CENSUS: 3DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Irma CastilloTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Conduct Inimical: Licensee forged signature on a Licensing form and submitted the document to CCLD office to obtain a license.
INVESTIGATION FINDINGS:
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On 5/20/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced complaint visit for the purpose of delivering the findings of the investigation regarding the allegation above. LPA met with Licensee, Irma Castillo. LPA observed 3 children in care.

During today's visit, LPA Casillas interviewed Licensee who stated she forged the landlord's signature on the LIC 9149 Landlord Consent form, which Licensee submitted to the Department for her application for a Change of Location. This interview was conducted in Spanish.

On 5/18/2022, LPAs Casillas and Judy Laureano conducted a 10-day complaint visit. LPAs observed 2 children in care. The facility roster showed 7 children enrolled. LPAs interviewed the Licensee who stated she received the LIC 9149 Landlord Consent form from the landlord via text message. LPAs asked to see the text;

[CONTINUE ON PAGE 2]
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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 30-CC-20220512113341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197495103
VISIT DATE: 05/20/2022
NARRATIVE
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PAGE 2

however, licensee stated she erases all of her text messages, including the text from the landlord with the LIC 9149. This interview was conducted in Spanish. Licensee submitted a signed LIC 855 Declaration attesting to her statements regarding the LIC 9149 to LPAs.

Licensee has been a licensed childcare provider since 2004 with a license for a large family childcare home since 2019. Licensee applied for a Change of Location on 4/1/2022. Upon processing the application, LPA Casillas requested the LIC 9149 from Licensee on 4/13/2022 via telephone and email. On 4/15/2022, LPA Casillas sent an email to the Licensee with information about the following: capacity for family child care homes with or without landlord consent, a PDF of the “Provider-Tenant Family Childcare Provider Guide” by Public Counsel, and contact information for Public Counsel. LPA Casillas reviewed the LIC 9149 on 4/20/2022, which was sent to the Regional Office by the Licensee via postal mail. On 5/11/2022, LPA Casillas and Licensing Program Manager (LPM) Maureen Neal made contact with the landlord who stated she did not grant consent or sign the LIC 9149 for the Licensee to care for two additional children. It is the responsibility of the Licensee to retain the original LIC 9149 form at the facility and post this form next to the facility license. Given that Licensee does not have an original LIC 9149 Landlord Consent form, the facility is restricted to a capacity of 12 children.

Based on observation, record review, and interviews with relevant parties conducted throughout the investigation, there a preponderance of evidence to prove the alleged violation did occur. Therefore, the allegation is SUBSTANTIATED. LPA Casillas issued two Type B deficiency citations during today's inspection (see LIC 9099-D for details).

An exit interview was conducted and a copy of this report along with the Notice of Site Visit and Appeal Rights were provided to Licensee, Irma Castillo.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20220512113341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197495103
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited
CCR
102417(q)(1)
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102417 Operation of a Family Child Care Home (q) A licensee...shall obtain the written consent of the property owner/landlord to increase the home's capacity to...14 children. (1) The licensee shall maintain the original of the completed and signed LIC 9149... This requirement was not met as evidenced by:
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The facility license will be restricted to a capacity of 12 children.
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Based on record review, observation and interviews, the Licensee did not ensure to obtain consent from the landlord nor maintain the original completed and signed LIC 9149, which poses a potential health, safety, or personal rights risk to children in care.
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Type B
05/20/2022
Section Cited
CCR
102402(a)(3)
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102402 Revocation or Suspension of a License or Registration (a) The Department shall have the authority to suspend or revoke any license...(3)Conduct...is inimical to the health, morals, welfare, or safety of... receiving services from the facility...This requirement was not met as evidenced by:
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Licensee agrees to retake the orienation for family child care homes by 5/27/2022. Licensee will submit a certification of completion to the Department by 6/3/2022 via postal mail and email.
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Based on interviews and record review, Licensee admitted to forging the landlord's signature on the LIC 9149 Landlord Consent form submitted to the Department, which poses a potential health, safety, or personal rights risk to 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.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
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