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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364842706
Report Date: 07/29/2021
Date Signed: 07/29/2021 12:10:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/20/2021 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20210720152148
FACILITY NAME:CORTEZ FAMILY CHILD CAREFACILITY NUMBER:
364842706
ADMINISTRATOR:CORTEZ, LUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 586-5789
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:14CENSUS: 8DATE:
07/29/2021
UNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Lupe Cortez/LicenseeTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Daycare infant sustained injuries while in care
Licensee did not ensure infant was fed while in care
INVESTIGATION FINDINGS:
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On 7/29/2021 at 11:39 AM Licensing Program Analyst (LPA) Patricia Berry conducted a complaint investigation to deliver final findings. LPA was granted access into the facility and was met by licensee. LPA toured facility and took a census.

Allegation: Daycare infant sustained injuries while in care
It was alleged a daycare child sustained injury while in care. LPA completed a file review and interviewed staff. Based on interviews conducted with the Licensee, the child was learning how to walk and came to the daycare in shoes which were too big for the child’s feet. Licensee stated she witnessed the child as child was falling.

(Cont on 9099C)






Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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 09-CC-20210720152148
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 364842706
VISIT DATE: 07/29/2021
NARRATIVE
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Although the child did sustain an injury while in care, LPA could not determine whether it was due to lack of supervision. Based on conflicting information received during interviews from what was alleged, the allegation daycare child sustained injury while in care is unsubstantiated.

Allegation: Licensee did not ensure infant was fed while in care
It was alleged licensee did not ensure infant was fed while in care. LPA conducted interviews with staff and children. Interviews conducted were conflicting on whether the child was fed while in care, therefore based on conflicting information licensee did not ensure infant was fed while in care is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



Exit interview conducted with director and report given. LPA observed director post Notice of Site Visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2