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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017124
Report Date: 09/15/2022
Date Signed: 09/15/2022 12:23:55 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2022 and conducted by Evaluator Jennifer Hua
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220908135442

FACILITY NAME:WILSON FAMILY CHILD CAREFACILITY NUMBER:
198017124
ADMINISTRATOR:WILSON, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 333-0679
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:14CENSUS: 0DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ana WilsonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Provider withholds feedings from infant(s)
INVESTIGATION FINDINGS:
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Complaint inspection conducted by Licensing Program Analyst Jennifer Hua. LPA arrived to facility at 8:55am, LPA knocked on the door and waited but no one answered the door. LPA waited outside the facility. At 9:12am, Licensee Ana Wilson arrived. Covid-19 risk assessement was conducted. LPA informed licensee the purpose of the visit. LPA observed no children in care. Licensee stated today, only 1 school-age child is scheduled to come after school. LPA reviewed allegation with licensee. Licensee's mother Maria Fuentes was also present. Assistant Rachel Fajardo arrived at 10:40am.

Interviews conducted with licensee, assistant and licensee's mother. Copy or facility obtained during visit.

It was alleged that infant was given only one bottle of 4 oz of milk the entire day infant was in care. Licensee and assistant confirmed that there was a mis-communication between them, licensee stated that she thought assisant gave infant another bottle and assistant thought licensee gave infant another bottle.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20220908135442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILSON FAMILY CHILD CARE
FACILITY NUMBER: 198017124
VISIT DATE: 09/15/2022
NARRATIVE
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This agency has investigated the complaint alleging provider withholds feedings from infant(s). Based on LPA's interviews which were conducted 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 are being cited on the attached LIC 9099D.

Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with Ana Wilson, licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. .
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20220908135442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WILSON FAMILY CHILD CARE
FACILITY NUMBER: 198017124
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2022
Section Cited
CCR
102423(a)(4)
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Personal Rights. Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To be free from
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Per licensee, from now on will document the time a bottle was given, put timer on phone 15 minutes prior to the next bottle and will assign bottles .
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unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. The requirement is not met as evidenced by: Licensee confirmed that there was a mis-communication between her and assistant, and child was only given 1 bottle of 4 oz milk while child was in care the entire day. This poses an immediate health and safety of 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: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4