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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444415939
Report Date: 09/12/2023
Date Signed: 09/12/2023 10:02:27 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, 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
09/05/2023 and conducted by Evaluator Elizabeth Berumen
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230905084136
FACILITY NAME:VASQUEZ, LORENAFACILITY NUMBER:
444415939
ADMINISTRATOR:LORENA VASQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 247-8372
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 7DATE:
09/12/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Jesus Morales and Lorena VasquezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Provider operating over ratio/capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Berumen met with Jesus Morales who states that Licensee, Lorena Vasquez is out dropping off a child at school. Licensee, Lorena Vasquez arrived shortly after LPA's arrival. Additional adults present were, Stephanie Torres Vasquez and Martin Mendoza Banuelos. LPA observed 5 infants and 2 preschoolers.

Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), is being cited on the attached LIC. 9099D.

NOTICE OF SITE VISIT WAS POSTED AND SHALL REMAIN POSTED FOR 30 DAYS ALONG SIDE TYPE A DEFICIENY.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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 07-CC-20230905084136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: VASQUEZ, LORENA
FACILITY NUMBER: 444415939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2023
Section Cited
CCR
102416.5(d)(1)
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Staffing Ratio & Capacity
For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants.
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Licensee agrees to submit a written plan of correction stating how she will comply with Staffing Ratio & Capacity
section 102416.5 and what her plan is to maintain capacity/ratio at all times.
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This requirement was not met as evidenced by: LPA observed 5 infants in care which poses an immediate risk to the health, safety, and personal rights of children in care.
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LIC9224 must be signed by all parents currently enrolled and submitted to Licensing by end of day 09/13/23. LIC9224 and LIC809 and 809D must be provided to all future enrollments for the next 12 months and maintained in file.
09/13/2023
Section Cited
CCR
102416.5(b)(3)
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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: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3