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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845425
Report Date: 11/20/2024
Date Signed: 11/20/2024 03:30:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2024 and conducted by Evaluator Susan Brewer
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20241113155824
FACILITY NAME:PENA-BRISENO FAMILY CHILD CAREFACILITY NUMBER:
334845425
ADMINISTRATOR:AMBAR PENA-BRISENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 246-8800
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY:14CENSUS: 7DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee Ambar BrisenoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee does not live in the day-care facility
Uncleared adult
INVESTIGATION FINDINGS:
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On the above date and time the Licensing Program Analyst (LPA) Susan Brewer, arrived unannouned at the facility for the purpose of initiating a complaint investigation into the above allegations. The LPA was greeted and granted entry into the facility by the Licensee Ambar Pena-Briseno. The LPA took a census of 7 children present.

The LPA Susan Brewer met with the Licensee Ambar Briseno to discuss the allegations regarding the License and Criminal Record Clearance. On today's date, the LPA made observations, conducted interviews with pertinent parties and obtained facility records related to the allegations.

It was alleged that the licensee does not live in the day care facility. LPA interviews with pertinent parties, records obtained and by the licensee's own admission during today's investigation revealed that as of 12/16/2023, the licensee moved out of the home and is now living in a separate dwelling. Based on evidence gathered and by the licensee's own admission, the allegation is determined to be Substantiated.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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 6
Control Number 09-CC-20241113155824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425
VISIT DATE: 11/20/2024
NARRATIVE
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LIC9099C Page 2 - Substantiated

It was alleged that the licensee employed uncleared adults to supervise daycare children: LPA observations made, records obtained and interviews conducted with pertinent parties revealed that two subject adults were observed supervising daycare children on a regular basis. The two uncleared adults were not present at the facility during today's date, however the licensee by their admission confirmed the two adults have been assisting with the supervision of daycare children and are not associated to the facility. Based on the evidence gathered through LPA observations, records obtained and interviews conducted the allegation is determined to be Substantiated.

Based on LPA’s observations and interviews which were conducted and review of records, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, 102352(f)(1) Definition and 102370(d)(1) Criminal Record Clearance are being cited on the attached LIC9099D.

The LPA Susan Brewer informed licensee Ambar Pena-Briseno that this report dated 11/20/2024 documents 102352(f)(1) Definition Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.



Also, LPA Susan Brewer informed the licensee Ambar Pena-Briseno to provide a copy of this licensing report dated 11/20/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A Type B violation was cited. See LIC809 Case Management report for additional deficiencies cited on today's date. No civil penalties were issued on today's date.

Exit interview conducted, a report was reviewed and a copy was left with the licensee Ambar Pena-Briseno.

A notice of site visit was given and must remain posted for 30 days. The licensee was reminded that a $100.00 civil penalty will assessed for the removal of the notice of site visit, before the 30 days.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 09-CC-20241113155824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2024
Section Cited
CCR
102352(f)(1)
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102352(f)(1) Definition "Family Day Care" or "Family Child Care" means regularly provided care, protection & supervision of children, in the care giver's own home...for less than 24 hours per day while parents or authorized representatives are away...
This regulation was not met as evidenced by:
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The licensee agrees to submit a written statement of understanding regarding the regulation and immediately cease operation of the daycare by close of business day on 11/21/2024, by providing proof of a written notification to cease operation to authorized representatives of daycare children.
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Based on LPA observations, interviews conducted, records gathered and by the licensee's own admission, as of 12/16/2023 the licensee no longer resides in the home where supervision of daycare children is provided, which is an immediate risk to the health & safety of children in care.
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In addition, the licensee agrees to submit a new application for relocation to the department, along with application fees on or before close of business day on 11/21/2024.
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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: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 09-CC-20241113155824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2024
Section Cited
CCR
102370(d)(1)
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102370(d)(1) Criminal Record Clearance: (d) All individuals subject to a criminal record review pursuant to Health & Safety Code § 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a CA clearance...
This regulation was not met as evidenced by:
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The licensee agrees to submit a written statement of understanding the regulation cited and a plan to ensure compliance with the regulation for 102370 Criminal Record Clearance in it's entirety. The licensee also agrees to submit the plan to the department by fax, mail or e-mail on or before 11/22/2024
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Based on interviews, records obtained and by the licensee's own admission, the licensee employed 2 uncleared adults to assist with supervision of daycare children, and employees did not complete a criminal record clearance, which is a potential risk to the health & safey of children in care.
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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: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2024 and conducted by Evaluator Susan Brewer
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20241113155824

FACILITY NAME:PENA-BRISENO FAMILY CHILD CAREFACILITY NUMBER:
334845425
ADMINISTRATOR:AMBAR PENA-BRISENOFACILITY TYPE:
810
ADDRESS:8775 54TH STREETTELEPHONE:
(909) 246-8800
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY:14CENSUS: 7DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee Ambar BrisenoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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2
3
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7
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9
Licensee yells at other adult resident in the home while in the presence of day-care children
INVESTIGATION FINDINGS:
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On the above date and time the Licensing Program Analyst (LPA) Susan Brewer, arrived unannouned at the facility for the purpose of initiating a complaint investigation into the above allegation. The LPA was greeted and granted entry into the facility by the Licensee Ambar Pena-Briseno. The LPA took a census of 7 children present.

The LPA met with the Licensee Ambar Briseno to discuss the allegations regarding Personal Rights. On today's date, the LPA made observations, conducted interviews with pertinent parties and obtained facility records related to the allegation.

It was alleged that the licensee licensee yells at other adult resident in the home while in the presence of day-care children. The LPA conducted interviews with pertinent parties and related to the allegation revealed the following:
See LIC9099C Page 2 - Unsubstantiated
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 09-CC-20241113155824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334845425
VISIT DATE: 11/20/2024
NARRATIVE
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LIC9099C Page 2 - Unsubstantiated: Licensee yells at other adult resident in the home while in the presence of day-care children

LPA interviews with Pertinent parties described the licensee and another adult resident yell in the presence of daycare children and during daycare hours, while other pertinent parties interviewed by the LPA denied the allegation that the licensee and other adult residents yell at daycare children. The LPA was unable to interview all individuals pertinent to the allegation were not present to interview Due to conflicting information gathered through interviews, other parties not present for the LPA to interview, the allegation is determined to to be Unsubstantiated.

Although the allegation that the Licensee yells at other adult resident in the home while in the presence of day-care children may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation/s did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, a report was reviewed and a copy was left with the licensee Ambar Pena-Briseno.

A notice of site visit was given and must remain posted for 30 days. The licensee was reminded that a $100.00 civil penalty will assessed for the removal of the notice of site visit, before the 30 days.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6