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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304300905
Report Date: 06/13/2022
Date Signed: 06/13/2022 02:45:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2022 and conducted by Evaluator Tina Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220324084349
FACILITY NAME:JACOBO-SEGUIN, CORINNEFACILITY NUMBER:
304300905
ADMINISTRATOR:JACOBO-SEGUIN, CORINNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 638-7510
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:14CENSUS: 10DATE:
06/13/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Staff Angelica RojasTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Adult placed a hot item on day care child while in care.
INVESTIGATION FINDINGS:
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On 06/13/2022 at 1:45 PM, Licensing Program Analyst (LPA) Tina Nguyen conducted an unannounced visit to deliver the finding regarding the above complaint allegation. This complaint investigation had been started on 03/04/2022 by LPA Tina Nguyen. LPA Nguyen met with Staff Angelica Rojas. LPA Nguyen touted the facility. The Covid-19 Emergency Response questionnaires were asked.
There was a total of 10 children with 2 staff members observed during the inspection. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 03/22/2022, the office received a complaint, and the complainant reported that Adult placed a hot item on day care child while in care. Complainant indicated that on 10/24/2021, child #4 reported that staff #1 put something hot on the child #4.
During the investigation, LPA interviewed 2 staff members and no disclosures were made by any staff member. All interviewed staff members denied of placing any hot item on the daycare children. No staff members disclosed witnessing any staff placing any hot item on any daycare child. Continue on page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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 2
Control Number 06-CC-20220324084349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: JACOBO-SEGUIN, CORINNE
FACILITY NUMBER: 304300905
VISIT DATE: 06/13/2022
NARRATIVE
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All interviewed staff stated if the children misbehaved or did not listen to the staff, the teacher would talk to the children and try to redirect the children to different activities.

LPA Nguyen contacted four parents by phone and was able to interview three parents. Interviewed parents also stated they did not have any safety concern with the staff and did not have any issue with the facility.
LPA Nguyen also conducted an interview with 3 children; interviewed children indicated that they like the teachers and did not have any staff placing hot item on them or witness any staff place hot item on any other friend.

Based on the information gathered from LPAs' interviews and reviewing records, there is insufficient evidence to corroborate the allegation of Adult placed a hot item on day care child while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged Adult placed a hot item on day care child while in care did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided. First level appeal is to Regional Manager, address is above on the report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2