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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 01:36:35 PM

Substantiated


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:
11:55 AM
MET WITH:Angelica PerezTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Care providers did not ensure that day care home had safe toys.
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 does not ensure that the FCCH has safe toys, parent interviews
Substantiated
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 3
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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revealed how parents have observe their children play with age appropriate toys at the FCCH. Parents are happy and satisfied with the level of care received for their children from Licensee and her assistant However during the site visits LPA's took pictures of the toys utilized at they FCCH. (see 812) One of the toys LPAs observed was a trampoline . The Licensee did not have the manufacturing instructions detailing the age range for the trampoline which appears to be for older children/adults and not age appropriate for young children. Also LPAs observed a toy truck that had a plastic sharp edge. Licensee stated during interview this truck was used by an infant at the FCCH, which resulted in the infant receiving a scratch on his face. Therefore, the allegation is substantiated.

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 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2024
Section Cited
CCR
102417(d)
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Operation of a Family Child Care Home
The home shall provide safe toys, play equipment and materials.

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The Licensee disposed of the trampoline and the toy truck in the presence of LPAs on 02/23/2024. Also Licensee stated she will review manufacturing directions of every toy and equipment used for day care chilldren to verify age appropriatness.
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Based on observations, interview, record review, the Licensee did not comply with the section cited above due to having inappropriate safe toys and equipment at the FCCH for young children.
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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: Ana Tolentino
LICENSING EVALUATOR NAME: German Negrete
LICENSING EVALUATOR SIGNATURE:

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

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3