<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004575
Report Date: 08/12/2021
Date Signed: 08/12/2021 05:09:10 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2021 and conducted by Evaluator Marie Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210526111108
FACILITY NAME:ESPINOZA, YADIRAFACILITY NUMBER:
414004575
ADMINISTRATOR:ESPINOZA, YADIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 315-4277
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:14CENSUS: 7DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Yadira EspinozaTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Two infants were left unattended in a pack and play.
- Licensee is using parts of her home for daycare that are not approved.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Marie Rodriguez conducted an unannounced inspection to deliver findings and close complaint. LPA met with Licensee Yadira Espinoza and explained purpose of visit. Licensee had six children in care (two infants and one preschool child and her three minor children). A seventh child arrived shortly after LPA's arrival.

During the course of the investigation, physical plant tour and interviews were conducted and pertinent documents and other evidence were reviewed. It was found based on information provided, two infants, Child C1 and C2, were inside one pack and play together both crying while Staff S1 was recording children. Although the infants were not left unattended with Staff S1 present, both infants should be in separate pack and plays. It was also found on date video was taken, Licensee was only operating in the lower level of her home and children should not be in an off-limit area nor a separate level of home from Licensee.

(Continued on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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 05-CC-20210526111108
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ESPINOZA, YADIRA
FACILITY NUMBER: 414004575
VISIT DATE: 08/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from LIC 9099)

Based on information gathered, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies cited today under California Code of Regulations, Title 22, Division 12, follows on LIC 9099D.

Report reviewed and discussed with Licensee Yadira Espinoza. Appeals Rights explained. A copy of report and Appeals Rights were provided to Licensee.
SUPERVISORS NAME: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20210526111108
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ESPINOZA, YADIRA
FACILITY NUMBER: 414004575
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/20/2021
Section Cited
CCR
102425(a)
1
2
3
4
5
6
7
Infant Safe Sleep (a) 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 has not been met as evidenced by:
1
2
3
4
5
6
7
Plan of correction (POC) will consist of Licensee reviewing CCLD videos on infant safe sleep and re-read PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect.
8
9
10
11
12
13
14
Based on video recording review, Licensee failed to ensure there was one crib or play yard for each infant in care. Two infants, Child C1 and C2, were seen in one pack and play together which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14
Office Meeting with Licensee has been scheduled for Monday, August 30, 2021 at 9:30am.
Request Denied
Type A
08/20/2021
Section Cited
CCR
102425(j)(6)
1
2
3
4
5
6
7
Infant Safe Sleep (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements:
(6) The provider shall be on the same floor as the sleeping infant.

This requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Plan of correction (POC) will consist of Licensee reviewing CCLD videos on infant safe sleep and re-read PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect.

8
9
10
11
12
13
14
Based on video recording review, Licensee failed to ensure infants in care were in the same floor as the Licensee. Two infants, Child C1 and C2, were located on the upper level of home in an off limit area while the Licensee was located in the lower level which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14
Office Meeting with Licensee has been scheduled for Monday, August 30, 2021 at 9:30am.
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: Alma Malig
LICENSING EVALUATOR NAME: Marie Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3