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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 444415939
Report Date: 04/26/2024
Date Signed: 04/26/2024 02:24:47 PM

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
10/31/2023 and conducted by Evaluator Teodoro Trujillo
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231031150208
FACILITY NAME:VASQUEZ, LORENAFACILITY NUMBER:
444415939
ADMINISTRATOR:LORENA VASQUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 247-8372
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:14CENSUS: 3DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lorena VasquezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Provider is not present at home to providing care and supervision to day care children in care.

Provider does not prevent children in care from accessing Sharpe and hazardous objects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teodoro Trujillo met with Lorena Vasquez to deliver complaint findings. The additional adults present were: adult daughter, Alma who assits, and licensee 17 year old daughter with 3 children in care: (One)1 preschool , two (2) infants.

LPA observed on site visit from 11/08/23, licensee Lorena left her 12 year old daughter alone with one infant and three preschool age children while she was doing errands.

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).

Continued on next LIC 909-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 07-CC-20231031150208
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: VASQUEZ, LORENA
FACILITY NUMBER: 444415939
VISIT DATE: 04/26/2024
NARRATIVE
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Type A deficiencies were cited during today's visit. LPA Teodoro Trujillo informed licensee Lorena Vasquez that this report dated 04/26/2024 document(s) 2 (two) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Teodoro Trujillo informed the licensee Lorena Vasquez to provide a copy of this licensing report dated 04/26/2024 that documents any Type A citation(s) 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.

Exit interview conducted and report was reviewed with licensee Lorena Vasquez.

NOTICE OF SITE VISIT WAS POSTED AND SHALL REMAIN POSTED FOR 30 DAYS ALONG SIDE TYPE A DEFICIENCY.
SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20231031150208
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: VASQUEZ, LORENA
FACILITY NUMBER: 444415939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2024
Section Cited
CCR
1024417(a)
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Operation of a Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
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Licensee will submit a written statement of her understanding of CCCR 1024417(a) to the San Jose Regional Office by close of buisness 04/27/24.
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This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above, Licensee Lorena was not present, licensee left her 12 year old child with 4 children in care, which posed an potential health, safety or personal rights risk to persons in care.
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Type A
04/27/2024
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety .... include but not be limited to:
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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LIcensee will submit a written statement of her understanding of CCR 102417(g)(4) and her preventive measures to prevent any future deficiencies by close of business 04/27/24.
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This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, a knife was accessible in kitchen sink, medicines and beauty products were in off limit bedroom where children were present, which posed an potential health, safety or personal rights risk to persons 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: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
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