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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336300957
Report Date: 05/09/2024
Date Signed: 05/09/2024 10:40:30 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 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
02/21/2024 and conducted by Evaluator Lorena Valenzuela
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240221085447
FACILITY NAME:DOMINGUEZ FAMILY CHILD CAREFACILITY NUMBER:
336300957
ADMINISTRATOR:DOMINGUEZ, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 834-5034
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:14CENSUS: 6DATE:
05/09/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sylvia DominguezTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Due to lack of supervision, child sustained a serious injury while in the care of provider.
INVESTIGATION FINDINGS:
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On May 9, 2024, Licensing Program Analyst (LPA) Lorena Valenzuela conducted an unannounced visit and met with Licensee, Sylvia Dominguez to deliver the findings of the above allegation.
On February 29, 2024, LPA Lorena Valenzuela conducted a health and safety inspection of the facility. Copies of children’s roster, and other facility and children's documents were obtained. Interviews were conducted with licensee, one assistant, and three parents/authorized representatives.
On February 21, 2024, the Department received information that due to lack of supervision a child sustained a serious injury while in care of the provider. It was reported that Child 1 (C1) was picked up from the day care by parent/authorized representative and C1 could not stand or bear weight on C1’s feet.
Confidential interviews revealed Child 1 (C1) arrived at the home being able to walk. Interviews revealed C1 took a nap at 10:30am and woke up at 11:30am. Witness interviews revealed after C1 woke up from the nap, C1 was uncomfortable when C1 placed weight on their feet, or tried to stand.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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 2
Control Number 10-CC-20240221085447
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300957
VISIT DATE: 05/09/2024
NARRATIVE
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Additional interviews revealed C1 was not observed falling or being injured prior to C1’s wake up time.
Based on interviews and records review, that due to lack of supervision a child sustained a serious injury while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report, appeal rights and Notice of Site Visit were provided to licensee, Sylvia Dominguez.
The Notice of Site Visit was posted by the licensee prior to LPA leaving the facility and the licensee was reminded this notice must be posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2