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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334844818
Report Date: 01/26/2022
Date Signed: 01/26/2022 02:57:45 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
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: 4DATE:
01/26/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee, Patricia HernandezTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Daycare children sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Linda Almaraz and Sumayya Habebulla made an unannounced visit to conduct further investigation in regards to the above allegations. LPA's were greeted by Licensee, Patricia Hernandez and explained the reason for todays visit.

The investigation consisted of the following: On 12/09/21, LPA's met with and interviewed Licensee and Staff Member Jessica Carlson, LPA's took census, toured the facility, reviewed records and conducted interviews. On 12/10/21, LPA's attempted to conduct additional interviews with children but LPA's had already interviewed current children present on 12/09/21. During todays visit LPA's interview additional children, former children who attended the child care home and Licensee.

(Continued on LIC-9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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 5
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:HERNANDEZ,PATRICIAFACILITY TYPE:
810
ADDRESS:2872 MAGELLAN LN.TELEPHONE:
(714) 234-4992
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:8CENSUS: 4DATE:
01/26/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee, Patricia HernandezTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Daycare child left facility unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Linda Almaraz and Sumayya Habebulla made an unannounced visit to conduct further investigation in regards to the above allegations. LPA's were greeted by Licensee, Patricia Hernandez and explained the reason for todays visit.

The investigation consisted of the following: On 12/09/21, LPA's met with and interviewed Licensee and Staff Member Jessica Carlson, LPA's took census, toured the facility, reviewed records and conducted interviews. On 12/10/21, LPA's attempted to conduct additional interviews with children but LPA's had already interviewed current children present on 12/09/21. During todays visit LPA's interview additional children, former children who attended the child care home and the Licensee.

(Continued on LIC-9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 01/26/2022
NARRATIVE
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The investigation revealed the following: It was alleged 2 children in the day care home left the facility without the knowledge of the licensee and went ding dong ditching in the neighborhood. It was alleged a toy car was used to climb over the fence to exit out of the facility. On 12/09/21, LPA's toured the backyard area and seen a pink large play car and 2 chairs next to the exit gate, one from the inside and one from the outside, side by side. Interviews conducted with the children revealed there were 3 children who left the house without the knowledge of the Licensee and went ding dong ditching in the neighborhood. A former child who attended the child care home stated they left the home to play ding dong ditch with another child who was the Licensee's granddaughter. The licensee later found out by a neighbor who informed her of what the children had done. Licensee denies the children enrolled were playing ding dong ditch and that they left unsupervised.

This agency has investigated the above allegation of "Day care child left facility unsupervised." Based on LPA’s interviews conducted this allegation is substantiated. See LIC9099-D for deficiency cited.

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.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA's VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2022
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times.....
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Licensee stated she will ensure all children are provided care and supervision at all times.
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This requirement was not met as evidency by: Children left the home unsupervised on more than one occasion without the knowledge of the licensee and were playing ding dong ditch in the neighborhood.
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Licensee will submit a written statement stating she has reviewed CCR 102417 (a) and will ensure all children in care are provided proper supervision at all times. The statement shall have a signature and will be sent to CCL by POC due date.
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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: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 01/26/2022
NARRATIVE
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The investigation revealed the following: It was alleged a child in the day care home had a toe injury and was bleeding from their toe and the parents were not notified. Interviews conducted revealed some kids have had falls. It is unknown if any of the falls or incidents resulted in bleeding or bruising. Per the Licensee, if a child has an injury they notify parents. She also stated that even if it requires a band aid she will text them or notify them verbally.

This agency has investigated the allegation of "Day care children sustained unexplained injuries while in care" and based on interviews conducted the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with the Licensee. Appeal rights provided, along with a copy of this report was issued. A copy of this report must be made available to the public for 3 years.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA's VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Linda M Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5