304313838-12-7-2023-06-CC-JHAN-CYJNXE-20231215095101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313838
Report Date: 12/07/2023
Date Signed: 12/07/2023 05:04:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
10/27/2023 and conducted by Evaluator Nguyen K Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20231027163125

FACILITY NAME:	GONGORA VALENCIA, MARIA DEL MAR		FACILITY NUMBER:	304313838
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Maria Gongora, Licensee		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Daycare child sustained an unexplained injury due to lack of supervision.

INVESTIGATION FINDINGS:

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On 12/07/23, Licensing Program Analyst (LPA) Tran and LPA Jung conducted an in-person investigation to deliver the findings regarding allegation that Daycare child sustained an unexplained injury due to lack of supervision. LPA Tran met with Licensee and informed Licensee the purpose of the visit.

A tour around the facility was conducted, and a census was taken. Observed at 2:45pm, was a total of 4 children inclduing 2 infants, 1 preschooler and 1 school age child being cared for by Licensee. At 3:15pm, Child #3 arrvied at the facility. Total was 5 children being supervised by Licensee and Adult #3.

A review of the Facility Personnel Report Summary on 12/07/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

(Continue next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20231027163125

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GONGORA VALENCIA, MARIA DEL MAR	FACILITY NUMBER: 304313838
	VISIT DATE: 12/07/2023

NARRATIVE

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(Page 2 of Report)

On 11/03/2023, the Regional Office received a complaint with allegation alleging day care child sustained an unexplained injury due to lack of supervision.

During a confidential interview, it was reported that Child #1 (C1) was observed with a red scratch across the forehead. Reporting Party (RP) suspected C1 sustained the injury while at the day care but could not confirm that C1 was observed with the red mark on the forehead upon pick up.

During the course of investigation, LPA Tran interviewed 3 adults in the facility, 1 child and 3 parents. LPA could not obtain permission from parent to interview subject child.

During the interviews, all interviewed adult denied Child#1 got injured at the facility. All interviewed adults stated Child #1 was picked up by parent on the day of the incident without any observable injury. LPA interviewed Child #2 (C2) at the facility on 12/07/2023, C2 stated Licensee is always there in the home to provide supervision for the children in care. C2 did not recalled any children in care was injured. LPA attempted to interview 8 parents, 3 parents responded and were interviewed. Interviewed parents disclosed no concerns with the care and supervision provided at the facility.

Based on the information gathered from LPA's interviews with 3 adults, 1 child and 3 parents, there is insufficient evidence to corroborate the allegation that Day care child sustained an unexplained injury due to lack of supervision. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove Day care child sustained an unexplained injury due to lack of supervision, therefore, the allegation regarding Day care child sustained an unexplained injury due to lack of supervision is unsubstantiated.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to the Licensee Maria Gongora. First level appeal is to Regional Manager, address is above on the report.
(End of Report)

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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