243809958-9-5-2024-04-CC-JMOA-D9PRLS-20241003130733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 243809958
Report Date: 09/05/2024
Date Signed: 09/05/2024 12:11:18 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2024 and conducted by Evaluator Miguel Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20240717110656

FACILITY NAME:	GOMEZ, BERTHA FCC		FACILITY NUMBER:	243809958
ADMINISTRATOR:	GOMEZ, BERTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 382-2612
CITY:	PLANADA	STATE: CA	ZIP CODE:	95365
CAPACITY:	14	CENSUS: 4	DATE:	09/05/2024
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Bertha Gomez		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee uses physical forms of punishment on children in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/05/2024, Licensing Program Analyst (LPA) Miguel Herrera conducted an unannounced complaint inspection. LPA met with Licensee, Bertha Gomez and provided interpretation services in Spanish. The purpose of the inspection was to deliver the findings for the above complaint allegation. A tour of the facility was conducted, and census was taken. During the course of the investigation LPA Herrera conducted interviews, made facility observations, and reviewed facility records to gather information to investigate the above allegation.
During interviews, a witness provided key details of the alleged incidents. The witness stated that child #3 was slapped in the head by Licensee Gomez and on another occasion child #4’s hair was pulled by Licensee Gomez. Furthermore, during parent interviews it was corroborated that Licensee Gomez slapped child #3’s head and pulled on child #4’s hair. Based on the information obtained during the investigation, the allegation that licensee uses physical forms of punishment on children in care was corroborated. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. To be continued on 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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 4

Control Number 04-CC-20240717110656

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
	VISIT DATE: 09/05/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Per California Code of Regulations, Title 22, Division 12, Chapter 3, a Type A deficiency is being cited on the attached LIC 9099D.
Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Licensee Bertha Gomez. Per licensee a completed signed copy of the LIC 9224 will be placed in each child's file.
An exit interview was conducted with Licensee Bertha Gomez. A copy of this report and Appeal Rights were provided and discussed with Licensee Bertha Gomez. A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 04-CC-20240717110656

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: GOMEZ, BERTHA FCC	FACILITY NUMBER: 243809958
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/06/2024 Section Cited CCR 102423(a)(4)	1 2 3 4 5 6 7	Personal rights. (a) Each child receiving services from a family child care home shall have certain rights...(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature...	1 2 3 4 5 6 7	Licensee has agreed to watch CCL Video: CHILDREN’S PERSONAL RIGHTS IN CHILD CARE which can be accessed by visiting the following website: ccld.childcarevideos.org.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews and records review, licensee did not ensure the personal rights of multiple children in care. This poses an immediate risk to the health, safety and/or personal rights of children in care.	8 9 10 11 12 13 14	Licensee stated that she would be completing a statement on what she learned and how she will ensure that personal rights of children will always be adhered to. The statement will be submitted to Fresno RO via email/text by 09/06/2024.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Juvenal Moctezuma	TELEPHONE: (559) 650-7869
LICENSING EVALUATOR NAME: Miguel Herrera	TELEPHONE: (559) 341-0721
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4