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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334844818
Report Date: 12/09/2021
Date Signed: 12/09/2021 05:20:41 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, 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
11/30/2021 and conducted by Evaluator Linda M Almaraz
COMPLAINT CONTROL NUMBER: 10-CC-20211130112205
FACILITY NAME:HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
334844818
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
12/09/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee, Patricia HernandezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee does not reside in the daycare home
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Linda Almaraz and Sumayya Habebulla made an unannounced visit for the purpose of initiating a complaint investigation, in regards to the above allegation. LPA's met with Licensee Patricia Hernandez and Staff Member Jessica Carlson, LPA's took census, toured the facility, reviewed records and conducted interviews.

The investigation revealed the following: Based on interviews conducted with the Licensee, staff and children the Licensee is residing across the street from the licensed home. Licensee stated she has been living across the street for a few months because she was trying to help her niece, Jessica. Per Licensee, her niece lives in the licensed home now with her husband and 5 children. Per interview with Jessica, she lives in both homes, the licensed home and across the street. LPA's did a walk-through of the rooms in the licensed home and confirmed there was only one room with a bed but had several storage items all over the room and no personal belongings of Jessica or the Licensee. (Continued on an LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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 10-CC-20211130112205
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 334844818
VISIT DATE: 12/09/2021
NARRATIVE
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Upon further interviewing with the Licensee, she informed LPA's both houses are her properties and the other home is her primary home were she showers, sleeps at and is on the weekends. LPA's also obtained a picture of the Licensee's Drivers License with the address of the home across the street. Licensee admitted they take the kids across the street to her house to swim and the kids will eat over there. She also stated sometimes she takes some of the kids to her house across the street to assist Jessica. On 12/9/21, LPA's conducted surveillance outside of the home and observe Licensee walking back with 3 children to the licensed home from her house. Video footage was obtained. Interviews with children also revealed they go to the Licensee's house and will stay there and provide snacks and food.

This agency has investigated the above allegation of "Licensee does not reside in the day care home." Based on LPA’s observations, interviews conducted, records obtained, and own admission this allegation is substantiated.

See LIC9099-D for deficiency cited. A Notice of Site Visit was posted.

An exit interview was conducted, appeal rights discussed and provided along with a copy of this report to Licensee on this date. A copy of this report must be made available to the public upon request for three years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 10-CC-20211130112205
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: HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 334844818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2021
Section Cited
CCR
102368(b)
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102368 License
(b) The license shall not be transferred to other individuals or locations.
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Licensee stated she will move back into the licensed home by POC due date. Licensee will submit a written statement with a signature, stating she will be residing at the licensed home and submit pictures of what room she will be living in.
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This requirement was not met as evidence by: Based on interviews conducted, surveillance video obtained, and own admission the Licensee is living across the street and not in the licensed home.
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CCR
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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: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4