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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566213327
Report Date: 11/03/2022
Date Signed: 11/03/2022 01:13:43 PM

Unsubstantiated


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
09/19/2022 and conducted by Evaluator Michael Mathew
COMPLAINT CONTROL NUMBER: 17-CC-20220919122126

FACILITY NAME:DELMAR FAMILY CHILD CAREFACILITY NUMBER:
566213327
ADMINISTRATOR:ANA DELMARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 582-2718
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:14CENSUS: 9DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana DelmarTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Provider is not meeting child's toileting needs.
Provider changed infant’s diet without authorized representative’s approval
INVESTIGATION FINDINGS:
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On 11/3/2022 at,10:00 AM Licensing Program Analysts (LPA) Michael Mathew conducted an unannounced inspection to conclude a complaint investigation and completed a COVID-19 pre-screening questions prior to entering the facility. LPA met with Licnsee Ana Delmar and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 9 children and 3 staff in care at the time of the inspection.

Allegations: Provider is not meeting child's toileting needs, and Provider changed infant’s diet without authorized representative’s approval. LPA conducted interviews with staff, parents and Reporting party LPA interviewed Reporting party who stated that Licensee was giving child 8 oz and later was giving 5 oz without RP consent, RP also stated that licensee is following the pediatric association guideline. RP also mention that that RP's mothers would pick up the child and when they get home it is full, LPA interview Licensee and staff who stated that parents will tell licensee how much the child need to drink and will not change unless licensee get consent from the parent.
Cont. 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20220919122126
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: DELMAR FAMILY CHILD CARE
FACILITY NUMBER: 566213327
VISIT DATE: 11/03/2022
NARRATIVE
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Licensee also stated that diapers are changes 4-5 times a day, and if the child has a rash Licensee will change the diaper and apply cream,if the rash is severe then licensee washes the child and changes diaper more often and will notify parents if child has a rash. LPA also interviewed parents who stated they are happy with the care a supervision of the children.

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.

"No deficiencies were cited on today’s visit"

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with Licensee Ana Delmar

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC9099 (FAS) - (06/04)
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