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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376629022
Report Date: 06/10/2024
Date Signed: 06/10/2024 11:40:15 AM

Substantiated


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
03/11/2024 and conducted by Evaluator Diana Sanchez
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20240311134301
FACILITY NAME:ROCHA, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
376629022
ADMINISTRATOR:CARMEN ROCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 403-9350
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY:14CENSUS: 5DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Carmen Rocha, ProviderTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Licensee is not reporting incidents involving day care child in care as necessary.
INVESTIGATION FINDINGS:
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On June 10, 2024, at 9:05 a.m., Licensing Program Analyst (LPA), Diana Sanchez made an unannounced complaint inspection to deliver the complaint investigation findings for the above allegation. LPA met with provider Carmen Rocha and explained the purpose of today’s inspection. Current census is 5.

This agency has investigated the above listed allegation. During the investigation, LPA conducted facility inspections, interviews with licensee, outside programs, daycare children and daycare parents.

It was alleged that the licensee did not report incidents involving daycare child #1 (C1) that occurred on 11/21/2023 and 03/06/2024, as necessary. Licensee denied the allegation, stating that she immediately informed C1’s parent of the incident that occurred on 11/21/2023, where C1 sustained an injury and was subsequently taken to the hospital by parent. Licensee stated that on the 03/06/2024 incident, she advised C1’s parent during pick up time. Although licensee notified parents about both incidents, she admitted to failing to report the 11/21/2023 incident to the Department as required.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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 20-CC-20240311134301
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: ROCHA, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629022
VISIT DATE: 06/10/2024
NARRATIVE
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Based on records reviewed and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 3), is being cited on the attached LIC 9099D.

Exit interview conducted and report was reviewed with provider Carmen Rocha. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 20-CC-20240311134301
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: ROCHA, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629022
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2024
Section Cited
CCR
102416.2(b)
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Reporting Requirements – The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

This requirement was not met as evidenced by:
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Provider Carmen Rocha stated that she will ensure to submit the required Unusual Incident/Injury Report (UIR) LIC-624B to the San Diego Child Care Regional Office (SDCCRO) by the due date of 06/11/2024.
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Based on interviews conducted, licensee’s admission & record review the licensee did not comply with the above regulation, as she didn't report the 11/21/2023 incident, which resulted in an injury to C1 that required medical treatment, as required, which poses a potential health, safety, or personal rights risk to persons 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: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/11/2024 and conducted by Evaluator Diana Sanchez
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20240311134301

FACILITY NAME:ROCHA, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
376629022
ADMINISTRATOR:CARMEN ROCHAFACILITY TYPE:
810
ADDRESS:10872 WAGON WHEEL DRIVETELEPHONE:
(619) 403-9350
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY:14CENSUS: 5DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Carmen Rocha, ProviderTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Daycare child sustained unexplained injuries while in care due to lack of licensee supervision.
INVESTIGATION FINDINGS:
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On June 10, 2024, at 9:05 a.m., Licensing Program Analyst (LPA), Diana Sanchez made an unannounced complaint inspection to deliver the complaint investigation findings for the above allegation. LPA met with provider Carmen Rocha and explained the purpose of today’s inspection. Current census is 5.

This agency has investigated the above listed allegation. During the investigation, LPA conducted facility inspections, interviews with provider, outside programs, daycare children and daycare parents.

It was alleged that on 11/21/23 and 03/06/24 daycare Child #1 (C1) sustained unexplained injuries while in care, as a result of a lack of supervision. Provider denied the allegation, explaining that on 03/06/2024, she was engaged in changing a child’s diaper and although she didn’t directly see the incident occur, she was present in the room and immediately tended to C1. On 11/21/2023, C1 ran into his sibling and falling resulting in a cut to C1’s head. According to the provider, she observed the two (2) siblings falling to the ground and immediately assisted them. Daycare children interviewed denied the seeing the incidents. Daycare parents interviewed did not raise any concerns regarding the children’s supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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-20240311134301
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: ROCHA, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629022
VISIT DATE: 06/10/2024
NARRATIVE
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There is insufficient evidence to support and no witnesses to corroborate the above allegation. LPA was unable to determine whether or not, the above allegation occurred. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted and report was reviewed with provider Carmen Rocha. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5