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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426216160
Report Date: 12/20/2023
Date Signed: 12/20/2023 12:31:27 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
10/06/2023 and conducted by Evaluator Francisca Velazquez
COMPLAINT CONTROL NUMBER: 17-CC-20231006153415
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: 13DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Marypaz PerezTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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1.) Facility is operating out of ratio/capacity.
INVESTIGATION FINDINGS:
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On 12/20/23, at 11:45 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced inspection of the Family Child Care Home (FCCH) to deliver the finding with respect to the allegation noted above. LPA met with Marypaz Perez, Licensee of the FCCH and explained the nature and purpose of the investigation. LPA notes 13 children are present at the time of the inspection with Licensee and Assistants, Dulce Escobar and Silvia Escobar.

The investigation included two (2) unannounced site inspections, record review, and interviews with the complainant, Licensee, as well parents of children enrolled in the FCCH.

The allegation references facility is operating out of ratio/capacity. LPA was able to corroborate the allegation based on documents received during the investigation it was found that FCCH is operating over capacity, based on attendance registers which identify more than fourteen (14) children present in the FCCH at once for the following months, June 2023-Novermber 2023. CONT LIC9099C and LIC9099D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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 5
Control Number 17-CC-20231006153415
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: 12/20/2023
NARRATIVE
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Based on LPA’s record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12 and 102416.5(d), is being cited on the attached LIC 9099 D).

A closing interview was conducted with Licensee, Marypaz Perez. Licensee was provided and advised of Appeal Rights. A copy of this report was reviewed and provided to the Licensee. LPA explained the facility's required plan of correction. Licensee was provided the Acknowledgement of Receipt (LIC 9224). Parents shall receive a copy of 9099, 9099C, and 9099D. Each parent/guardian shall sign and complete an LIC 9224 with copies maintained in each child's file. Every parent enrolling a new child in the facility shall receive a copy of the report and sign a LIC 9224 for the next twelve months. Licensee's signature at the bottom of this report acknowledges Licensee received the reports and understand their rights.

The Notice of Site Visit was also provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 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
10/06/2023 and conducted by Evaluator Francisca Velazquez
COMPLAINT CONTROL NUMBER: 17-CC-20231006153415

FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426216160
ADMINISTRATOR:MARYPAZ PEREZFACILITY TYPE:
810
ADDRESS:574 PALISADE DR.TELEPHONE:
(805) 863-3416
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 13DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Marypaz PerezTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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1.) Licensee does not spend adequate amount of time in the facility.
INVESTIGATION FINDINGS:
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On 12/20/23, a 11:45 AM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced inspection of the Family Child Care Home (FCCH) to deliver the finding with respect to the allegation noted above. LPA met with Marypaz Perez, Licensee of the FCCH and explained the nature and purpose of the investigation. LPA notes 13 children are present at the time of the inspection with Licensee and Assistants, Dulce Escobar and Silvia Escobar.

The investigation included two (2) unannounced site inspections, record review, and interviews with the complainant, Licensee, as well parents of children enrolled in the FCCH.

The allegation references licensee does not spend adequate amount of time in the facility. Interviews, as well as LPA's observations during unannounced site inspections did not corroborate the allegation noted above. Licensee was present during unannounced inspections and interviews with parents did not reveal any concerns with the care and supervision their children receive at the FCCH or with the licensee not being present in the home. CONT 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 17-CC-20231006153415
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: 12/20/2023
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A Notice of Site Visit (LIC 9213) and Appeal Rights (LIC 9058) was provided to Licensee, Marypaz Perez. The Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 17-CC-20231006153415
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: 12/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2023
Section Cited
CCR
102416.5
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102416.5- Staffing Ratio and Capacity- (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by:
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Licensee agrees to submit a written declaration detailing how Licensee will review the schedules of the families enrolled and make changes to make ensure that Licensee does not go over the capacity specified on the license.
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Record review, specifically attendance registers submitted by licensee for payment revealed, licensee provided care for more than fourteen (14) children at a time during the months of June 2023-November 2023. This is an immediate risk to the health and safety of children in care.
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Declaration will be submitted by 12/21/23 via email at Francisca.Velazquez@dss.ca.gov
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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: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5