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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376628572
Report Date: 09/08/2025
Date Signed: 09/08/2025 03:04:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 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
06/12/2025 and conducted by Evaluator Shannan Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20250612112113
FACILITY NAME:GOMEZ, CINTHYA FAMILY CHILD CAREFACILITY NUMBER:
376628572
ADMINISTRATOR:CINTHYA GOMEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 253-7472
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:14CENSUS: 2DATE:
09/08/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cinthya GomezTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Licensee did not notify to authorized representative of injury to a child in care.
INVESTIGATION FINDINGS:
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On September 8, 2025, 12:30 PM, Licensing Program Analyst (LPA) Shannan Williams conducted an unannounced complaint inspection for the purpose of delivering the finding regarding the above allegation. LPA with met with Licensee Cinthya Gomez children two (2) children present at the time of the inspection.

It was alleged that the Licensee did not notify the authorized representative of injury to a child in care.

During the course of the investigation, interviews were conducted with the Licensee, witnesses, the children involved, authorized representative and reporting party. LPA collected images of injuries sustained and reviewed medical documents. The Licensee admitted that on June 6,2025, at around 2:30pm, Child #2 (C2) tripped and fell onto the floor when jumping out of a standard wooden infant crib located in the daycare room and injured her legs. The Licensee denied that the child fell on her face or head during the fall. The Licensee stated that she was in front of the crib when the child fell. The Licensee stated ice was applied to C2's legs.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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 20-CC-20250612112113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GOMEZ, CINTHYA FAMILY CHILD CARE
FACILITY NUMBER: 376628572
VISIT DATE: 09/08/2025
NARRATIVE
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C2 was interviewed and stated that she fell and hurt her eye at the daycare. One witness Child 1 (C1) was interviewed and stated C2 tripped when jumping out of the infant crib and hit her face and legs on the floor and C1 stated that the Licensee was approximately two feet from the crib when the incident occurred.

During the course of the investigation the Licensee stated that she did not inform C2's authorized representative about the injury on June 6, 2025, as she thought the child just bumped her legs which she believed to be a typical injury from children rough playing.

The preponderance of evidence standard has been met, therefore the allegation that the Licensee did not notify the authorized representative of an injury of a child in care is found to be substantiated. California Code of Regulations, title 22, Division 12 & Chapter 3, is being cited on the attached LIC 9099D.

A notice of site visit was given to the Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Licensee, Cinthya Gomez. .






SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 20-CC-20250612112113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: GOMEZ, CINTHYA FAMILY CHILD CARE
FACILITY NUMBER: 376628572
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2025
Section Cited
CCR
102416.2(f)(1)
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(f) As soon as possible but no later then the same business day, the licensee shall notify a child's parent regardless of the injuries that affect that child.... (1) Any injury suffered by a child in care shall be reported to that child's parents... regardless of treatment by a medical professional.
This requirement is not met as evidenced by:
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The Licensee stated she will text or make a note to the parent's or authorized representative the same day if an injury occurs. The Licensee stated that she will document the injury with images if possible and send them to the parent or representative.
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Based on interviews the Licensee did not comply with the section cited above by not notifying the child's parents of an injury that occured on 06/06/2025, which posed a potential threat 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: Cynthia Biszant
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
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
SAN DIEGO CC RO, 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
06/12/2025 and conducted by Evaluator Shannan Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20250612112113

FACILITY NAME:GOMEZ, CINTHYA FAMILY CHILD CAREFACILITY NUMBER:
376628572
ADMINISTRATOR:CINTHYA GOMEZFACILITY TYPE:
810
ADDRESS:1384 SUTTER BUTTES STREETTELEPHONE:
(619) 253-7472
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:14CENSUS: 2DATE:
09/08/2025
ANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cinthya GomezTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Child sustained an injury while in care due to lack of supervision.
INVESTIGATION FINDINGS:
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On September 8, 2025, at 1:00 PM, Licensing Program Analyst (LPA) Shannan Williams conducted an unannounced complaint inspection for the purpose of delivering the finding regarding the above allegation. LPA with met with Licensee Cinthya Gomez two (2) children present at the time of the inspection.

It was alleged that a chiild sustained an injury while in care due to lack of supervision..

During the course of the investigation, interviews were conducted with the Licensee, witnesses, the children involved, authorized representative and reporting party. LPA collected images of injuries sustained and reviewed medical documents. The Licensee admitted that on June 6,2025, at around 2:30pm, Child #2 (C2) tripped and fell onto the floor when jumping out of a standard wooden infant crib located in the daycare room and injured her legs. The Licensee denied that the child fell on her face or head during the fall. The Licensee stated that she was in front of the crib when the child fell. The Licensee stated ice was applied to C2's legs.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 20-CC-20250612112113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GOMEZ, CINTHYA FAMILY CHILD CARE
FACILITY NUMBER: 376628572
VISIT DATE: 09/08/2025
NARRATIVE
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C2 was interviewed and stated that she fell and hurt her eye at the daycare. One witness Child 1 (C1) was interviewed and stated C2 tripped when jumping out of the infant crib and hit her face and legs on the floor and C1 stated that the Licensee was approximately two feet from the crib when the incident occurred.

Due to conflicting interview statements and information obtained during the course of the investigation. 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, therefore the allegation is unsubstantiated. No deficiencies were cited.
A notice of site visit was given to the Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Licensee, Cinthya Gomez.


SUPERVISORS NAME: Cynthia Biszant
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5