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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198400324
Report Date: 04/14/2022
Date Signed: 04/14/2022 11:10:49 AM

Unsubstantiated


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 CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2022 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20220118133158
FACILITY NAME:DAVALOS FAMILY CHILD CAREFACILITY NUMBER:
198400324
ADMINISTRATOR:ANGELICA DAVALOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 601-7190
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:14CENSUS: 2DATE:
04/14/2022
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Licensee Angelica Davalos TIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Daycare provider throws children in the pool when they don't know how to swim.
Provider slaps daycare children.
Provider locks children in the bathroom.
Provider puts tape on the daycare child's mouth.
INVESTIGATION FINDINGS:
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On 4/14/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced complaint inspection to the above facility. LPA met with Licensee, Angelica Davalos, and informed of the reason for the visit. Licensee guided analyst on a tour of the facility. There were 2 children present.

During the course of the investigation, LPA reviewed pertinent documents and conducted interviews.
Although interviews did not corroborate the allegations, interviews did reveal that use of the pool by children was allowed with parental permission and attendance. Also, even though interviews revealed that children use the bathroom that is on limits which does not have a lock, LPA did observe that the off - limits bathroom can be locked from the outside. Furthermore, interviews did not corroborate that the provider has slapped day care children or that they have put tape on a child’s mouth. Per interviews, the Licensee’s discipline policy is to talk to the children and/ or offer an alternate activity and speak with their parent about the issue.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
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 5
Control Number 54-CC-20220118133158
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVALOS FAMILY CHILD CARE
FACILITY NUMBER: 198400324
VISIT DATE: 04/14/2022
NARRATIVE
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Based on information obtained during the investigation, the allegation was determined to be unsubstantiated. Unsubstantiated – A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited today. Exit interview was conducted with Facility Representative. The Notice of Site Visit (LIC 9213) and the Appeal Rights were given and explained to the Facility Representative.
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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5