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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343623966
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:57:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/12/2024 and conducted by Evaluator Fabian Schwartz
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20241212132024
FACILITY NAME:QUERO-FLORES, MARTHAFACILITY NUMBER:
343623966
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Martha Quero-FloresTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Lack of supervision resulted in child wandering away from the home - Substantiated
INVESTIGATION FINDINGS:
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On Monday 16 December 2024, at approximately 1:45pm, Licensing Program Analyst (LPA) Fabian Schwartz met with Licensee Martha Quero-Flores, for the purpose of opening and closing a complaint investigation of the above allegation. Upon arrival, LPA observed Licensee supervising 4 napping preschool children. Also present at time of inspection were licensee's 2 adult children.

It was alleged that a child had left front door of facility. Throughout the course of investigation, LPA conducted observations, reviewed records, and conducted interviews. It was determined by record review and interviews that a preschool child (Child 1) had managed to leave front door of facility and make it to the street without the knowledge of the licensee.Based on LPA observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

Report Continued on LIC-9099-C.....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 3
Control Number 03-CC-20241212132024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: QUERO-FLORES, MARTHA
FACILITY NUMBER: 343623966
VISIT DATE: 12/16/2024
NARRATIVE
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Report continued from LIC-9099......

Title 22 deficiencies are cited on the subsequent pages of this report. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Licensee. LIC 9224 and Appeal Rights were provided. Licensee's signature on this report acknowledges receipt of these rights.


This report was reviewed with the Licensee and an exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 03-CC-20241212132024
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: QUERO-FLORES, MARTHA
FACILITY NUMBER: 343623966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2024
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. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement was not met as evidenced by:
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Licensee will install door latch to prevent openings to door and will review supervision requirements for licensees by 17 December 2024.
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Based on Record review and interviews, the licensee did not comply with the section cited above by having Child #1 leave front door of facility and walk to street which poses an immediate health, safety or personal rights risk 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: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3