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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406216229
Report Date: 02/23/2024
Date Signed: 02/23/2024 01:34:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/13/2023 and conducted by Evaluator German Negrete
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20231213142047
FACILITY NAME:PEREZ FCC MAYA'S CAREFACILITY NUMBER:
406216229
ADMINISTRATOR:ANGELICA PEREZ CARDENASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 458-0422
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:14CENSUS: 7DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Aneglica PerezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Care providers did not provide adequate supervision, resulting in day care child sustaining multiple injuries.
Care providers did not follow safe sleeping practices.
INVESTIGATION FINDINGS:
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On 2/23/2024, Licensing Program Analyst (LPA) German Negrete and Sylvia Ceja conducted an unannounced inspection at the Family Child Care Home (FCCH) to deliver the findings of the above mentioned complaint allegations received on12/13/2024. LPAs toured the FCCH inside and out. LPAs observed licensee and her assistant providing care and supervision to 2 infants and 5 children (over 2 years of age).

The investigations included otaining the child care roster, interviewing parents currently and previously enrolled in care, reviewing children's records including the Infant Sleep Charts, as well as LPA''s observation.

Regarding the allegation, Care providers did not provide adequate care supervision, resulting in day care child sustaining multiple injuries, LPA interviewed multiple parents. Parents interviewed stating their children have never sustained any injury at the FCCH. Parents stated they are satisfied with the level of care their children receive in the family child care home. Continued on 809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 2
Control Number 17-CC-20231213142047
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEREZ FCC MAYA'S CARE
FACILITY NUMBER: 406216229
VISIT DATE: 02/23/2024
NARRATIVE
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 LPA interviewed licensee and staff which concluded the licensee and staff provide adequate supervision. Licensee stated she was there when an infant was crawling and playing with a plastic toy truck that had a plastic sharp piece attached. The infant fell on a toy truck and sustained a scratch on the infant's face. In addition, there was a second incident which happened so fast when a child was eating a cookie and another child bit the child's wrist (no broken skin). Based on the interviews with the Licensee and her assistant, LPA found no evidence pertaining to this allegation and is found to unsubstantiated.

Regarding the allegation, Care providers did not follow safe sleeping practices. LPAS conducted a review of infant sleep charts. Also LPA conducted parent interviews which revealed parents have not had any concerns about safe sleep practices at this FCCH. On 12/15/2023, during an unannounced inspection LPAs interviewed licensee and her assistant. In addition, LPAs reviewed Infant Safe Sleep Charts which were found to be complete. Based on the interviews with the Licensee and her assistant, LPA found no evidence pertaining to this allegation and is found to unsubstantiated.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did nor did not occur, therefore the allegation is Unsubstantiated.

Exit Interview conducted and report was reviewed with Licensee Angelica Perez
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Notice of Site Visit and appeal rights were issued.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2