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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364846404
Report Date: 07/24/2024
Date Signed: 07/24/2024 09:15:40 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 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
03/19/2024 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240319084822
FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
364846404
ADMINISTRATOR:SMITH, TANINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 994-6857
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:14CENSUS: 2DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Tanina Smith/licenseeTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Reporting Requirements
INVESTIGATION FINDINGS:
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On 7/24/24 at 8:10 am, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation. LPA met with licensee toured facility and took a census.

Allegation: Reporting Requirements

During the investigation, LPA determined the licensee did not report to Community Care Licensing (CCL) there was an allegation of a child sustaining unexplained injuries and the allegation was reported to law enforcement. Licensee stated she did not know she had to inform CCL.



(Cont on 9099C)
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 5
Control Number 09-CC-20240319084822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 364846404
VISIT DATE: 07/24/2024
NARRATIVE
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Based on interview conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. See LIC 9099D for deficiency cited.

Exit interview conducted with Taninia Smith, report, appeal rights and notice of site visit issued.

Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 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
03/19/2024 and conducted by Evaluator Patricia Berry
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20240319084822

FACILITY NAME:SMITH FAMILY CHILD CAREFACILITY NUMBER:
364846404
ADMINISTRATOR:SMITH, TANINAFACILITY TYPE:
810
ADDRESS:6715 LONDON AVETELEPHONE:
(909) 994-6857
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:14CENSUS: 2DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Tanina Smith/LicenseeTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Child sustained unexplained injuries while in care
INVESTIGATION FINDINGS:
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On 7/24/24 at 8:10 am, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation. LPA met with Tanina Smith toured facility and took a census.

Allegation: Child sustained unexplained injuries while in care.

It was alleged a child sustained an abrasion on their body. LPA interviewed all pertinent parties and reviewed video footage. In addition to investigating, the allegation was investigated by law enforcement.

Staff stated the child was not injured at the facility and did not see the child hurt by another child or staff. LPA observed some video footage; however, was unable to determine if the child was injured while at the facility.

(Cont on 9099C)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 09-CC-20240319084822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 364846404
VISIT DATE: 07/24/2024
NARRATIVE
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Based on interviews conducted and video footage reviewed, there is conflicting information from what was alleged; therefore, the allegation is unsubstantiated. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted with Tanina Smith, report, appeal rights and notice of site visit issued.

Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 09-CC-20240319084822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SMITH FAMILY CHILD CARE
FACILITY NUMBER: 364846404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2024
Section Cited
CCR
102416.2(a)(3)(C)
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Reporting Requirements (a) The licensee shall report... telephone...Department's next business day... (3) ...A report shall be made to the Department…following.. (C) Any unusual incident..
This requirement was not met as eveidenced by
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Licensee submitted the Unusual Incident Report to LPA during visit.

POC cleared today.
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Based on interview conducted the licensee did not submit an Unusual Incident Report in a timely manner.

This is a potential risk to the health and safety of children 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: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5