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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426216160
Report Date: 06/27/2023
Date Signed: 06/27/2023 04:54:54 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
06/23/2023 and conducted by Evaluator Martina Jimenez
COMPLAINT CONTROL NUMBER: 17-CC-20230623121344
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426216160
ADMINISTRATOR:MARYPAZ PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 863-3416
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 14DATE:
06/27/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Mary Paz PerezTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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1. Licensee did not prevent the spread of head lice
2. Licensee did not notify daycare children representative of unusual incident
INVESTIGATION FINDINGS:
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On 06/27/2023 at 10:45 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced inspection with Mary Paz Perez, licensee, Dulce Livier Escobar-Aguilar, Assistant, and Dulce Athziri Garduno Escobar, assistant, who arrived to the FCCH at 11:27am, to initiate a complaint investigation.

LPA arrived to the home the licensee and assistants were a caring for fourteen (14) children from six (6) months - five (5) years olds. The purpose of the inspection was discussed. LPA interviewed the Licensee and day-care children in regards to the allegations referenced above. LPA requested the FCCH roster, the licensee will email LPA the FCCH roster by 6/28/2023.

Licensee stated that on 6/22/2023, licensee received a t/c from mother of C1. The mother was calling to advise the licensee that C1 had head lice, and that the licensee should advise the parents of the children in care.
This report continues on LIC9099C & LIC9099
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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-20230623121344
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216160
VISIT DATE: 06/27/2023
NARRATIVE
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The licensee stated that mother has taken C1 to Mexico for three (3) weeks, then C1 went to stay with the father for a week, then return to care on 6/12/2023, and three (3) days after returning to care the mother advised the licensee that C1 had head lice and to notify the parents of the children in care.

The licensee stated that the licensee only notified two (2) of the parents; C2 & C3 that C1 had head lice. No other parents were notified of the head lice.

On 6/25/2023, Licensee stated that licensee's assistant noticed at 2:30pm that C3 & C4 had head lice. Licensee stated that at 4:30pm, when mother picked up C3 & C4 licensee advised the mother that C3 & C4 had head lice. The mother stated I forgot to tell you that the school sent a notice that there was head lice at the school.

Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s), that the Licensee did not prevent the spread of head lice, and Licensee did not notify day-care children parents of the heading lice incident, are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

An exit interview was conducted, and Plan of Correction was reviewed and developed with the licensee. A copy of this report and appeal rights were discussed and left with the licensee.

Today’s visit was conducted in Spanish. Today, deficiency cited under Title 22 Division 12 Appeal rights given. LPA observed the Notice of Site Visit posted.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20230623121344
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216160
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2023
Section Cited
CCR
102423(a)(2)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe
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Licensee will submit a written plan of correction on how licensee will prevent future incidents to CCLD by 07/06/2023, email to Martina.Jimenez@dss.ca.gov
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healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidence by: Licensee stated that licensee Isolate or send children with head lice other children in care. This poses an potential Health and Safety risk to children in care.
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Type B
07/06/2023
Section Cited
CCR
102416.2(f)
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As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized representative regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a). This requirement is not met
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Licensee will submit a written plan of correction on how licensee will prevent future incidents to CCLD by 07/06/2023, email to Martina.Jimenez@dss.ca.gov
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as evidence by: Licensee stated that no other parents were notified of the head lice. This poses an potential Health and Safety risk to children 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: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3