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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364818501
Report Date: 11/07/2023
Date Signed: 11/07/2023 07:16:18 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
05/24/2023 and conducted by Evaluator Rachel Zeron
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230524171333
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
364818501
ADMINISTRATOR:PEREZ, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 628-9819
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:14CENSUS: 1DATE:
11/07/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Dolores PerezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Adult in home inappropriately touched daycare children while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rachel Zeron and Blanca Ruiz conducted an visit with Licensee, Dolores Perez. The purpose of the visit is to deliver the substantiated findings of the above complaint allegation.This inspection was conducted in Spanish per Licensee’s request, LPA Ruiz conducted the translation. An in-person 10-day inspection was initiated by LPA Zeron on May 25, 2023. During the initial inspection, LPA obtained pertinent documentation needed for the investigation, and met with the Licensee, Dolores Perez. The following was observed and discussed with Dolores:

Although, LPA Rachel Zeron initiated the complaint investigation on May 25, 2023 and is delivering the substantiated findings, the complaint allegation was investigated by Investigations Branch (IB) Investigator, Marlon Williams.
Per interviews conducted, and information gathered, the investigation revealed while in care at the facility, an adult residing in the home inappropriately touched daycare children. Evidence collected by IB Investigator Williams alleges that Licensee, Dolores Perez was not aware of these incidents and had no knowledge these incidents occurred at her facility. Dolores stated that she is always present while children are in care. The Licensing Department served an Order of Immediate Exclusion for Adult the was residing in the home on 09/07/2023.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
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-20230524171333
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 364818501
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2023
Section Cited
CCR
102423(a)(1)
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 Personal Rights. (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee…(1) To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by:
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 Adult has been excluded from the facility for life. A Non Compliance Conference will be scheduled for a later date.
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Based on interviews, records obtained throughout the investigation, it was found that an Adult inappropriately touched children in care. Adult posed immediate and continutous threats to the health, safety, and personal rights to multiple children in care.
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This violation results in an Enhanced Civil Penaltiy (ECP) which has been approved by the department and has been assessed in the amount of $2000.00. Advisement of this ECP was discussed during the exit interview.
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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: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230524171333
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 364818501
VISIT DATE: 11/07/2023
NARRATIVE
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Based on interviews with pertinent parties and records obtained throughout the investigation, the department has determined the preponderance of evidence standard has been met, therefore the allegation of personal rights is found to be SUBSTANTIATED. See LIC9099 D for deficiency cited per California Code of Regulations Title 22, Division 12.

An enhanced civil penalty has been assessed by the department. This violation results in an Enhanced Civil Penalty (ECP) which has been approved by the department and has been assessed in the amount of $2000.00. A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

LPA informed the license, that this report dated 11/07/23 documents (1) Type A citation(s) which shall be posted for 30 consecutive days as there was an immediate risk to the Health, Safety, or Personal Rights of children in care. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) was provided to facility during this inspection. The Lic 9224/Type A citation must be provided to parents/guardian 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 the verification.

An exit interview was conducted with Licensee, Dolores Perez and appeals rights were discussed. LPAs Zeron and Ruiz provided Licensee a copy of this report, Enhanced Civil Penalty, appeal rights, and Notice of Site Visit. LPA observed the Notice of Site Visit form was posted by Licensee. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.




SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3