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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334846056
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:40:08 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 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
08/06/2023 and conducted by Evaluator Taityana Benson
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230806204348
FACILITY NAME:MEDRANO FAMILY CHILD CAREFACILITY NUMBER:
334846056
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Amanda Medrano, LicenseeTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Reporting Requirements-Failure to report incident to licensing office
INVESTIGATION FINDINGS:
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On November 16, 2023, Licensing Program Analyst (LPA) Taityana Benson arrived at Medrano Family Child Care Home to conclude the investigation regarding the above allegation, a previous inspection was conducted on August 15, 2023. LPA met with Licensee, Amanada Medrano and conducted a tour of the facility inside and outside. During the investigation, interviews were conducted with pertinent parties and documentation was collected.

On August 06, 2023, a complaint was received alleging a child was observed with scratch(es) or bite(s) on their face as a result of being bitten by the Licensee’s dog.

During interviews, it was discovered that the Licensee’s dog “scratched and/or bit” a child in care. The Licensee and Assistant were present when the incident occurred, on or about July 31, 2023. The child was in the Licensee’s view and witnessed the child being “scratched or nipped” by their dog.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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 3
Control Number 09-CC-20230806204348
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MEDRANO FAMILY CHILD CARE
FACILITY NUMBER: 334846056
VISIT DATE: 11/16/2023
NARRATIVE
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It was discovered that the child did not require medical attention and was provided first aid (ice applied to injured area) by the Licensee. The dog was immediately placed in their kennel behind a locked door, in an off-limits area, inaccessible to children.

However, it was disclosed that the Licensee did not submit an Unusual Incident Injury/Report to the department in regard to the child being bitten. The Licensee did not contact the department via telephone to report the incident nor did Licensee inform their assigned Licensing Program Analyst or the subject child’s parent(s). The Licensee indicated they did not believe the incident required reporting to the department because the child was “okay” and did not require medical attention. Furthermore, it was disclosed the subject child’s parent(s) became aware of the incident by the child.

Based on LPA observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division &Chapter number), are being cited on the attached LIC 9099D.”)

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SEE LIC 9099-D for the deficiencies cited

Exit interview conducted and report was reviewed with the Licensee, Amanda Medrano.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230806204348
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MEDRANO FAMILY CHILD CARE
FACILITY NUMBER: 334846056
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2023
Section Cited
HSC
1597.467(b)(1)(C)
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1597.467(b)(1)(C) A report shall be made to the department by telephone or fax during the department's normal business hours...next working day...of any of the following events: Any unusual incident....that threatens the physical or emotional health or safety of any child.
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Licensee agrees to complete a detail Unusual Incident Injury/Report, LIC624 for the incident that occurred on or about 07/31/2023 and submit it to the department via fax (951) 782-4985 or via email:
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**This is an amended document,original report 11/16/2023** Based on interviews and record review, Licensee did not submit a report to the department when a child in care was nipped by their dog, which poses an potential Health and Safety, Personal risks to persons in care.
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UnusualIncidentReportsDO09@dss.ca.gov by 11/20/2023 and provide proof to LPA via email by COB 11/20/2023.
Type B
11/20/2023
Section Cited
CCR
102416.2(f)(1)
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102416.2(f)(1) Any injury suffered by a child in care shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional.
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Licensee agrees to immediately develop a plan for reporting unusual incidents and or injuries to the parents of children in care. Licensee agrees to provide a copy of the developed plan to LPA via email by COB 11/20/2023.

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**This is an amended document, original report 11/16/2023** Based on interviews and record review, Licensee did not inform the parents of a child in care that their child was nipped by their dog, resulting in a minor injury, which poses an potential Health and Safety, Personal risks to persons 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: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
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