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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566216213
Report Date: 04/29/2024
Date Signed: 04/29/2024 03:23:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 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
03/11/2024 and conducted by Evaluator Aaliyah Zendejas
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20240311130629
FACILITY NAME:FLORES FCC AKA KOODAKAN DAYCAREFACILITY NUMBER:
566216213
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
04/29/2024
UNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Fanny SaudiaTIME COMPLETED:
03:47 PM
ALLEGATION(S):
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Licensee allowed uncleared adults to live in the home
INVESTIGATION FINDINGS:
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On April 29, 2024, Licensing Program Analysts (LPAs) Susana Martinez and Aaliyah Zendejas conducted an unannounced visit to the abovementioned facility to deliver the findings of the complaint. LPAs met with the licensee's assistant, Fanny Sudia and advised them of the purpose of the inspection to which the assistant stated that the licensee was out at an appointment. There were 3 children in care at the time of the inspection. LPAs toured the facility interior and exterior with assistant.

The department received an allegation indicated that the Licensee allowed uncleared adults to live in the home. LPAs conducted staff interviews as well as parent interviews to gain more information on the allegation. Licensee admitted to allowing two unfingerprint cleared adults stay in the home for three days. LPAs obtained a written declaration from one of the adults staying in the home verifying that they did infact stay at the facility.

Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
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 17-CC-20240311130629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FLORES FCC AKA KOODAKAN DAYCARE
FACILITY NUMBER: 566216213
VISIT DATE: 04/29/2024
NARRATIVE
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Based on LPAs interviews which were conducted, documents gathers, and record reviews, the preponderance of evidence has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

Also, LPA's informed the assistant, Fanny Sudia to provide a copy of this licensing report dated 04/29/2024 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.

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 assistant, Fanny Sudia.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20240311130629
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FLORES FCC AKA KOODAKAN DAYCARE
FACILITY NUMBER: 566216213
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2024
Section Cited
CCR
102370(a)
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102370 Criminal Record Clearance (a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement was not met as evidence by:
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LPAs verified that adults are no longer living in the home. In office meeting will be held at a later date.
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Based on LPAs observation, interview, and record review, the licensee did not comply with the section cited above as an adult living in the home failed to conduct a criminal record clearance which poses/posed an immediatel 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: George Mingle
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3