<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376626280
Report Date: 10/26/2022
Date Signed: 10/26/2022 01:43:21 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2022 and conducted by Evaluator Dana Stevens
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20220729161340
FACILITY NAME:GOMEZ, CYNTHIA FAMILY CHILD CAREFACILITY NUMBER:
376626280
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Cynthia GomezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not notify representative of daycare child's illness
Licensee did not change an child diaper
Infant was left with a soiled diaper for extended period of time resulting in a diaper rash
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/26/2022 at 1:10 PM Licensing Program Analyst (LPA) Dana Stevens conducted an unannounced complaint inspection. LPA met with Licensee, Cynthia Gomez, to deliver complaint findings on the above allegations. There were 5 daycare children present with Licensee and Licensee's assistant at the time of this inspection.

Throughout the investigation LPA interviewed Licensee, Licensee’s assistant, a witness, daycare children and daycare parents and reviewed facility records and documentation.

1) Licensee did not notify representative of daycare child's illness.
Based on information obtained in interviews and LPA's review of documentation that included photos, though the department received information that a child’s illness was not reported, due to lack of medical documentation as well as lack of validation of the time and date the illness occurred by witnesses, there was not a preponderance of evidence to support this allegation, thus this allegation is deemed Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 20-CC-20220729161340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GOMEZ, CYNTHIA FAMILY CHILD CARE
FACILITY NUMBER: 376626280
VISIT DATE: 10/26/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
2) Licensee did not change an child diaper.
Based on information obtained in interviews and LPA's review of documentation that included photos, though the department received information that Licensee did not change a child’s diaper, LPA was not able to corroborate this information with witnesses. Due to a lack of evidence of a pattern of negligence on the part of the Licensee, there was not a preponderance of evidence to support this allegation, thus this allegation is deemed Unsubstantiated.


3) Infant was left with a soiled diaper for extended period of time resulting in a diaper rash.
Based on information obtained in interviews and LPA's review of documentation that included photos, though the department received information that an Infant was left with a soiled diaper for an extended period of time resulting in a diaper rash, LPA was not able to corroborate this information with witnesses. Due to lack of validation of the information by witnesses and since children can get diaper rashes for reasons other than wet/soiled diapers, there was not a preponderance of evidence to support this allegation thus this allegation is deemed Unsubstantiated.
.
A finding that the complaint is unsubstantiated means that although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited.

An exit interview was conducted and copy of this report and appeal rights were left with Licensee. Notice of Site Visit must be posted for 30 days
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2