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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 406216951
Report Date: 12/02/2024
Date Signed: 12/02/2024 04:55:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/14/2024 and conducted by Evaluator Elvin Baddley
COMPLAINT CONTROL NUMBER: 17-CC-20241014191651
FACILITY NAME:HERNANDEZ-MEDINA FCC AKA LITTLE BLESSING DAYCAREFACILITY NUMBER:
406216951
ADMINISTRATOR:HERNANDEZ-MEDINA, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 710-7489
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 5DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Mayra Hernandez-MedinaTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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1. Licensee does not follow infant safe sleep protocols with day care child(ren) in care.
INVESTIGATION FINDINGS:
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On 12/4/24, at 3:10 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Matthew Sapien made an unannounced inspection to deliver the finding with regard to the investigation into the abovementioned allegation. LPA met with Mayra Hernandez-Medina, Licensee of the noted Family Child Care Home (FCCH). LPAs explained the nature and purpose of the inspection to Licensee. LPAs notes five children are on site at the time of the inspection, along with three assistance providing care and supervision.

The investigation included two unannounced inspections, LPA's observations and record reviews, as well as a random sampling of interviews of current parents of children in care. The Complainant in this matter was also interviewed. It should be noted children in care were not interviewed given their ages/maturity.

Interviews, record reviews and LPAs' observations did corroborate infant safe sleep protocols were not followed at the FCCH, Namely, the Licensee slept two infants (C1 and C2) in care in a single playyard. Licensee was reminded infants in care should sleep in their own specific playyard/crib.
(CONT. LIC. 9099, Page 2)


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/14/2024 and conducted by Evaluator Elvin Baddley
COMPLAINT CONTROL NUMBER: 17-CC-20241014191651

FACILITY NAME:HERNANDEZ-MEDINA FCC AKA LITTLE BLESSING DAYCAREFACILITY NUMBER:
406216951
ADMINISTRATOR:HERNANDEZ-MEDINA, MAYRAFACILITY TYPE:
810
ADDRESS:8987 CURBARIL AVENUETELEPHONE:
(831) 710-7489
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 5DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Mayra Hernandez-MedinaTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
1. Licensee did not isolate day care child(ren) with signs of illness while in care.
2. Day care child sustained diaper rash due to neglect.
INVESTIGATION FINDINGS:
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On 12/4/24, at 3:10 PM, Licensing Program Analysts (LPAs) Elvin Baddley and Matthew Sapien made an unannounced inspection to deliver the finding with regard to the investigation into the abovementioned allegations. LPAs met with Mayra Hernandez-Medina, Licensee of the noted Family Child Care Home (FCCH). LPAs explained the nature and purpose of the inspection to Licensee. LPAs notes five children are on site at the time of the inspection, along with three assistance providing care and supervision.

The investigation included two unannounced inspections, LPA's observations and record reviews, as well as a random sampling of interviews of current parents of children in care. The Complainant in this matter was also interviewed. It should be noted children in care were not interviewed given their ages/maturity.

Interviews, record reviews and LPAs' observations did not corroborate allegations #2 or #3. Specifically, there were no indications the Licensee failed to isolate day care children with signs of illness while in care. Additionally, there are no indications children in care sustained diaper rashes given the neglect of the
(CONT. LIC. 9099, Page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 17-CC-20241014191651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSING DAYCARE
FACILITY NUMBER: 406216951
VISIT DATE: 12/02/2024
NARRATIVE
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Licensee.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

A Notice of Site visit (LIC 9213)was given and must remain posted for 30 days. Licensee provided Appeal Rights (LIC. 9058).



Exit interview conducted and report was reviewed with the Licensee Mayra Hernandez-Medina.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 17-CC-20241014191651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSING DAYCARE
FACILITY NUMBER: 406216951
VISIT DATE: 12/02/2024
NARRATIVE
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Based on LPAs' observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099 D.

A Notice of Site visit (LIC 9213) was given and must remain posted for 30 days. Licensee provided Appeal Rights (LIC. 9058).

Exit interview conducted and report was reviewed with the Licensee Mayra Hernandez-Medina.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 17-CC-20241014191651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSING DAYCARE
FACILITY NUMBER: 406216951
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2024
Section Cited
CCR
102425(a)
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There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. This requirement was not met as evidenced by: Licensee slept C1 and C2 in a single playyard. This poses an potential risk to health, safety or personnel rights of persons in care.
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Licensee will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations as it applys to sleeping children in their own playyard/crib. Written plan will be submiited to CCLD
(elvin.baddley@dss.ca.gov.) by 12/16/24.
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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: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5