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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376603119
Report Date: 06/26/2024
Date Signed: 06/26/2024 01:10:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 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
03/19/2024 and conducted by Evaluator Keely Messerschmidt
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240319125325
FACILITY NAME:BUGIELSKI, MARYGRACE FAMILY DAY CAREFACILITY NUMBER:
376603119
ADMINISTRATOR:BUGIELSKI, MARYGRACEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 945-2221
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:14CENSUS: 7DATE:
06/26/2024
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:MaryGrace BugielskiTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Lack of supervision resulted in an infant sustaining multiple bite injuries from another child
INVESTIGATION FINDINGS:
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On Wednesday June 26th, 2024 at 12:10 PM, Licensing Program Analyst (LPA) Keely Messerschmidt met with licensee MaryGrace Bugielski to deliver the findings for the above stated complaint allegation. The investigation was conducted by Special Investigator Annette Renquist. During today’s inspection, LPA toured the facility and took census. LPA observed 2 infants, 4 toddlers and 1 preschooler in care, total of 7 children.

On March 31, 2024, a complaint was received alleging lack of supervision resulting in an infant sustaining multiple bite injuries from another child. The Licensee was interviewed and stated on March 15, 2024, she had placed 6 children and infants in one bedroom with six pack and plays to nap. The pack and plays were observed to be close in space to each other. The licensee stated her assistant (A1) had left the house and that her second assistant (A2) was in the process of coming over to replace A1.

(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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 4
Control Number 10-CC-20240319125325
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BUGIELSKI, MARYGRACE FAMILY DAY CARE
FACILITY NUMBER: 376603119
VISIT DATE: 06/26/2024
NARRATIVE
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Licensee stated she heard a child crying in the sleeping area, but she was occupied and was not able to check on the child for approximately five to seven minutes. Licensee stated when she did check, she found Child #1 (C1) with marks on their face and a dot of blood on both the forehead and lip. The licensee noticed Child #2 (C2) was in the pack and play next to C1. She also indicated the pack and play C2 was in, was not the one they had been placed in to take a nap. The licensee indicated she did not know what the red marks were until she observed C2 bite another child later that day. The licensee stated she applied ice to C1’s face and notified the parents. After picking C1 up from the provider, the parents took C1 to Urgent Care. Per medical records obtained, C1 was observed with a bite mark to the left shoulder, the right elbow, and bite marks to the face. The medical records also indicated the bite marks were consistent with bites from another toddler.

It is important to note that during this time, and specifically on March 15, 2024, the Licensee was providing care and supervision without a valid license. Per the Licensee’s Request for Inactive Child Care License Status form (LIC 9211), signed and dated by the licensee on February 21, 2024, the license requested to be on inactive status from February 26, 2024, through August 26, 2024. On March 15, 2024, the licensee did not have a valid license. However, through the licensees’ actions, it was demonstrated that she intended to provide care and supervision, despite the fact that she did not have a valid license. In addition, on March 15, 2024, the licensee violated regulations by failing to submit an Unusual Incident Report to report injuries sustained by Child #1 (C1) on that day.

Based on the information gathered during the investigation there is sufficient evidence to prove the lack of care of supervision which resulted in day-care child sustaining multiple bite injuries from another child, therefore, the allegation is substantiated. See LIC809-D page for cited Type A deficiency.

A Civil Penalty has been assessed on this visit. 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.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 10-CC-20240319125325
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BUGIELSKI, MARYGRACE FAMILY DAY CARE
FACILITY NUMBER: 376603119
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2024
Section Cited
HSC
1596.885(c)
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Denial, suspension or revocation of license, registration, or special permits; grounds: The department may deny an application for or suspend or revoke any license, registration, or special permit issued under this act upon any of the following grounds and in the manner
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Licensee reactivated her license on 3/21/24 so that she could continue to provide care and supervision with a valid license. Licensee agrees to provide a statement of understanding to include that she must operate her facility in full compliance of the regulations, have an active license when providing care and supervision to children, and if licensee chooses to go inactive again, she understands she cannot provide care and supervision to children.”
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provided in this act: (c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. This requirement was not met as evidenced by: Based on interviews, licensee provided care and supervision to children on 3/15/24, despite requesting to be on inactive status from 2/26/24 through 8/26/24 and not having a valid license. This posed an immediate health, safety or personal risk to the 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: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 10-CC-20240319125325
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BUGIELSKI, MARYGRACE FAMILY DAY CARE
FACILITY NUMBER: 376603119
VISIT DATE: 06/26/2024
NARRATIVE
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Upon receipt, licensee shall post 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 for the next 12 months.

An exit interview was conducted, and this report was reviewed with the Licensee, MaryGrace Bugielski, and a copy was provided. Appeal rights were discussed and provided during the exit interview. The Notice of Site Visit and Type A Deficiencies from today’s visit must be posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4