Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153902186
Report Date: 05/13/2019
Date Signed: 05/13/2019 11:24:22 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2019 and conducted by Evaluator Rene Mancinas
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190319160454
FACILITY NAME:MARTINEZ, ANA & TERESA FAMILY CHILD CAREFACILITY NUMBER:
153902186
ADMINISTRATOR:MARTINEZ, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 835-9904
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 5DATE:
05/13/2019
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana Martinez TIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to secure child into a car seat.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Rene Mancinas Jr and Jose Penate, conducted an unannounced complaint inspection to provide finding regarding the above allegation. LPAs met with Licensee, Ana Martinez. LPA discussed the allegation and took a census. During the investigation LPA Mancinas interviewed licensee, parents, children, and obtained facility records. Children interviews revealed that child #1 was not secured properly in an approved car seat or booster as required by regulations. Based upon observations, and information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Per California Code of Regulatios Title 22 Division 12 Chapter 3; the following deficiency is being cited. (See-9099-D). Appeal Rights were provided. Exit interview conducted with Ana Martinez. Notice of Site Visit to be posted for 30 days.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2019 and conducted by Evaluator Rene Mancinas
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20190319160454

FACILITY NAME:MARTINEZ, ANA & TERESA FAMILY CHILD CAREFACILITY NUMBER:
153902186
ADMINISTRATOR:MARTINEZ, ANAFACILITY TYPE:
810
ADDRESS:3117 HUGHES LANETELEPHONE:
(661) 835-9904
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:14CENSUS: 5DATE:
05/13/2019
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana Martinez TIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately grabbed child.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Rene Mancinas Jr and Jose Penate, conducted an unannounced complaint inspection to provide finding regarding the above allegation. LPAs met with Licensee, Ana Martinez. LPA discussed the allegation and took a census. During the investigation LPA Mancinas interviewed licensee, parents, children, and obtained facility records. 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.

Per California Code of Regulations Title 22 Division 12 Chapter 3, no deficiency is being cited. Exit interview conducted with Ana Martinez. Notice of Site Visit to be posted for 30 days.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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 3
Control Number 04-CC-20190319160454
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MARTINEZ, ANA & TERESA FAMILY CHILD CARE
FACILITY NUMBER: 153902186
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2019
Section Cited
CCR
102417(k)
1
2
3
4
5
6
7
All vehicle occupants must be secured in an appropriate restraint system. This requirement was not met as evidenced through investigation and interviews with children. This is a potential
1
2
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5
6
7
Licensee understands children must be secured appropriately as required by California car seat / booster laws and Title 22 regulations.
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9
10
11
12
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14
risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
CCR
1
2
3
4
5
6
7
1
2
3
4
5
6
7
ILS
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3