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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444406227
Report Date: 07/08/2025
Date Signed: 07/08/2025 11:31:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2024 and conducted by Evaluator Martha Jimenez-Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240828101954
FACILITY NAME:FERNANDEZ, ROSALIAFACILITY NUMBER:
444406227
ADMINISTRATOR:FERNANDEZ, ROSALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 763-2095
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 13DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosalia FernandezTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Daycare child sustained suspicious injury while in care
INVESTIGATION FINDINGS:
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On 7/8/2025, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee, Rosalia Fernandez, to deliver complaint findings. Present was licensee with assistant Maria Delgado Ortiz with 13 children in care: two infants, nine toddlers and two schoolers.

The Investigation Branch (IB) has investigated the allegation: Daycare child sustained suspicious injury while in care. During the course of the investigation, it was found that a daycare child had lost two teeth during daycare hours. Based on IBs investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

LPA Martha Jimenez-Villanueva informed licensee Rosalia Fernandez that this report dated July 8, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Coninues in next page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 4
Control Number 07-CC-20240828101954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FERNANDEZ, ROSALIA
FACILITY NUMBER: 444406227
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/08/2025
Section Cited
CCR
102423(2)
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Each child receiving services from a family child care home shall have certain rights...To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement was not met as evidence by:
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Licensee will review regulation and submit a written statement of her understanding of the regulation and how she will prevent this from happening again by end of business day on 07/09/2025.
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Based on the IB investigation, it was found that a daycare child had lost two teeth during daycare hours. This poses an immediate risk to the health, safety, and personal rights of the 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: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2024 and conducted by Evaluator Martha Jimenez-Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240828101954

FACILITY NAME:FERNANDEZ, ROSALIAFACILITY NUMBER:
444406227
ADMINISTRATOR:FERNANDEZ, ROSALIAFACILITY TYPE:
810
ADDRESS:443 ROGGE STREETTELEPHONE:
(831) 763-2095
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 13DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosalia FernandezTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Licensee did not notify child’s authorized representative of child’s injury
INVESTIGATION FINDINGS:
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On 7/8/2025, Licensing Program Analyst (LPA) Martha Jimenez-Villanueva met with licensee, Rosalia Fernandez, to deliver complaint findings. Present was licensee with assistant Maria Delgado Ortiz with 13 children in care: two infants, nine toddlers and two schoolers.

This department has investigated the allegation: licensee did not notify child’s authorized representative of child’s injury. Interviews with relevant parties were conducted and it was found that statements were inconsistent on whether licensee had notified the authorized representative of child’s injury. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Rosalia Fernandez in Spanish.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 4
Control Number 07-CC-20240828101954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FERNANDEZ, ROSALIA
FACILITY NUMBER: 444406227
VISIT DATE: 07/08/2025
NARRATIVE
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Also, LPA Martha Jimenez-Villanueva informed the licensee to provide a copy of this licensing report dated 07/08/2025 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An immediate $500 civil penalty has been assessed and documented on LIC 9099 D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Rosalia Fernandez in Spanish.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Martha Jimenez-Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4