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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 233007628
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:55:04 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2023 and conducted by Evaluator Leticia Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230912112719
FACILITY NAME:ALVAREZ, MARIA(ANGELICA) FCCHFACILITY NUMBER:
233007628
ADMINISTRATOR:ALVAREZ, MARIA (ANGELICA)FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 513-0520
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: DATE:
12/01/2023
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maria Angelica AlvarezTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Licensee did not follow the terms and conditions of the license.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Leticia Rosales-Meza conducted a subsequent complaint investigation inspection, for the purpose of delivering complaint findings, and met with the Licensee, Maria (Angelica) Alvarez. It was alleged that Licensee did not follow the terms and conditions of the license, specifically Licensee submitted fraudulent documents to Subsidy Program for the month of July 2023 and August 2023.

During the initial complaint investigation to the facility on 9/18/23, records were reviewed, and the LPA conducted an interview with the Licensee. The Licensee stated she understands and admits she broke the law by putting times in and out at her facility, while she was out of the Country, but that she was planning to pay her assistant with those funds. Licensee stated her assistant whom is also her neighbor provided care for the children in her own home. Licensee stated "I did it to help the parents out, but did it intentionally without harm".

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
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 3
Control Number 01-CC-20230912112719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: ALVAREZ, MARIA(ANGELICA) FCCH
FACILITY NUMBER: 233007628
VISIT DATE: 12/01/2023
NARRATIVE
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During the course of the investigation, LPA conducted interviews with three adults, made observations, reviewed records, and obtained additional documents. To qualify for the Subsidized Payment Program, a Licensee is obligated to maintain accurate records to verify children’s attendance for the child care.

According to the documents obtained, Licensee certified under penalty of perjury by signing the attendance sheet showing five children receiving care for the month of July and August 2023, when the Licensee was out of the Country and the facility closed.

Furthermore, records obtained by Community Care licensing outlined Serious Deficiency Determination of this facility on July 25, 2023 to August 9, 25, 2023 for “Falsification of Documentation”, Willful Misrepresentation”, and “Lack of Business Integrity”. These findings are based on a review of records which reflect the Licensee entered times in and out on the monthly records when children were found not to be in attendance at her facility.

Based on the information obtained, and records reviewed during the investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22 is being cited on the attached LIC 9099-D. Appeal rights were provided.

LPA Leticia Rosales-Meza informed Licensee, Maria (Angelica) Alvarez that this report dated 12/01/23 documents one Type A citation. Type A citations shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.



Also, LPA Rosales-Meza informed the Licensee to provide a copy of this licensing report dated 12/01/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted, and report was reviewed and discussed with the Licensee, Maria (Angelica) Alvarez.

A notice of site visit was given and must remain posted for 30 days from today's date. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20230912112719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ALVAREZ, MARIA(ANGELICA) FCCH
FACILITY NUMBER: 233007628
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/02/2023
Section Cited
HSC
1596.885(c)
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Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state
This requirement was not met as evidenced by:
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Licensee stated she will submit a written statement of a procedure to ensure all documents are accurately submitted, within 24 hours. Licensee will also submit proof of attendace sheet showing accurate times in/out to
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Based on Licensee submitted fraudulent documents to receive Subsidy Program funds by showing inaccurate time in and out entries on monthly records at her facility, while Licensee was out of the Country, and children were found not to be in attendance, which poses an immediate health and safety risk to the children in care.
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LPA Rosales-Meza by 12/06/23 via email, mail, or fax.

Email: leticia.rosales@dss.ca.gov
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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: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC9099 (FAS) - (06/04)
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