Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198012910
Report Date: 06/26/2018
Date Signed 06/26/2018 03:27:15 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2018 and conducted by Evaluator Carlos Gonzalez
COMPLAINT CONTROL NUMBER: 33-CC-20180620150313
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198012910
ADMINISTRATOR:JIMENEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 358-2752
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:14CENSUS: 13DATE:
06/26/2018
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Veronica Jimenez, Licensee TIME COMPLETED:
02:18 PM
ALLEGATION(S):
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Licensee operating over capacity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPAs) Carlos Gonzalez and Karen Chambers conducted a complaint investigation to the above facility. LPAs met with Veronica Jimenez, Licensee, who guided Analyst's on a tour of the facility at which time the census was taken and the names and ages of children present was noted. Also present was Licensee's assistant, Kristen Maldonado. LPAs observed thirteen (13) children in care at the time of inspection, four (4) of whom were infants.

Licensee stated during her interview conducted at 12:34pm that a birthday party took place last Wednesday, June 20, 2018, from 11:45 AM to 1:15 PM, for a family member. At the time of the party there were 19 children present; of the 19 children present 14 were day-care children, four (4) of her nephews, ages six, eight, and two (2) twins age thirteen and one (1) neighborhood child who was 4 1/2 years old. Based on Licensee's statement, the parents of her four nephews were not present at the time of party, nor the neighborhood child's parent present. Licensee also stated that she was present along with her three ( 3) assistant's, Lindsey McGaffey, Elizabeth and Kristen Maldonado at the time of the party.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
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 4
Control Number 33-CC-20180620150313
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2018
Section Cited
CCR
102371(a)
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A fire safety clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal shall be required for a large family child care home. Licensee did not meet this requirement as evidenced by:

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Per Licensee, a written statement will be provided to address this matter by the POC due date.
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on 06/20/18, Licensee confirmed during her
interview that there were 19 children in care at the facility of which 14 were day care children. This included four family members, two of which were over the age of 10 and one neighboorhood child and two family members under the age of 10. This poses an immediate risk to the health and safety of children 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.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 33-CC-20180620150313
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2018
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. Licensee did not meet this requirement as evidenced by: Licensee's statement in that 19 children were present on 06/20/18, which
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Per Licensee, the facility will be closed when a birthday party takes place and a written statement will be provided to address this matter by the POC due date.
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exceeds the capacity limitation. Per Licensee's statement, three of the extra four children were under the age of ten and parents/guardians were not present. The other two children in care were over the age of ten. This poses an immediate risk to the health and safety of children in care.
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Type A
06/27/2018
Section Cited
HSC
1597.465(b)
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A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met: No more than three infants are cared for during any time when more than 12 children are being cared for.
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Licensee stated that child #2 will be not be admitted into the day care facility after close of business today (06/26/18).
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Licensee did not meet this requirement as evidenced by: LPAs observed thirteen children in care at the time of inspection, four of whom were infants. This was confirmed by the facility roster and names/ages provided by the Licensee. This poses an immediate risk to the health and safety of children 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.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20180620150313
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 06/26/2018
NARRATIVE
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During this inspection the Licensee provided the facility roster which was observed to be incomplete. A picture of the roster was taken.

A confidential names list was provided to the Licensee with 24 names and birth dates listed.

Based on observations made during this visit of the children in care, with verification noted from the facility roster as well as the Licensee confirming the names and ages of children present during the 6/20/2018 party, the preponderance of evidence has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations Title 22 Division 12 Chapter 3 is being cited.

The notice of site visit was posted where the parent/guardian of children enter and exit the facility. A copy of this report shall also be posted where the parent/guardian enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent or guardian of children currently in care by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of children newly enrolled in the program for the next 12 months.

Exit interview conducted with the Licensee, during which appeal rights were explained and provided (LIC9058 01/16) The Licensee's signature on this report acknowledges receipt of her rights.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 4