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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334844622
Report Date: 08/25/2022
Date Signed: 08/25/2022 02:00:53 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/26/2022 and conducted by Evaluator James Wilkerson
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20220726151334
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
334844622
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
08/25/2022
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Laura RodriguezTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee did not seek medical attention for child's injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to conclude an investigation into the above allegation. There was an initial visit conducted on 07/29/22 that was extended at that time. During today's visit, LPA toured the facility and conducted census. During the course of this investigation, interviews were conducted with the licensee and other pertinent parties involved. There was an allegation made that a child had fallen and received a cut on the forehead that required stitches and that the licensee did not seek medical attention in a timely manner for the child. The licensee denies this and stated that the child was being picked up at the facility by a parent/gurepresentative jus moments after the accident happened. There was conflicting information received by LPA from an interview that the injury did not look "fresh". While the licensee acknowledges the injury happened at the faciliy, LPA is unable to verify how long the child had the injury prior to the parent/guardian/representative's arrival due to the conflicting information received from the interviews.

SEE NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
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 10-CC-20220726151334
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334844622
VISIT DATE: 08/25/2022
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, A Notice of Site Visit posted, appeal rights discussed and provided to the licensee along with a copy of this report on this date
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: James Wilkerson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2