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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426216160
Report Date: 09/20/2023
Date Signed: 09/20/2023 07:22:06 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
09/14/2023 and conducted by Evaluator Martina Jimenez
COMPLAINT CONTROL NUMBER: 17-CC-20230914092213
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: 8DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
04:33 PM
MET WITH:MaryPaz PerezTIME COMPLETED:
07:35 PM
ALLEGATION(S):
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Facility provider is not isolating child with lice
INVESTIGATION FINDINGS:
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On 09/20/2023 at 4:33 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced inspection with MaryPaz Perez, licensee, Dulce Escobar-Aguilar, Assistant, and Melissa Vasquez Alvarado, assistant/daughter, who arrived to the FCCH at 4:45Ppm, to initiate a complaint investigation.

LPA arrived to the home the licensee and assistants were a caring for eight (8) children from ten (10) months - eleven (11) 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 obtained the FCCH roster.

LPA interviewed children in care, which revealed C1, C2, C3, & C4, corroborate the above allegations.

Licensee stated that since the previous complaint on 6/23/23, there has not been any children received with head lice and denies the allegations.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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-20230914092213
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: 09/20/2023
NARRATIVE
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Based on LPAs observation, interviews with licensee, and children, which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s), Facility provider is not isolating child with lice, 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: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20230914092213
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: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2023
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 09/27/2023, 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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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: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3