Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434414668
Report Date: 02/26/2020
Date Signed: 02/26/2020 12:43:04 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2020 and conducted by Evaluator Dayna Collier
COMPLAINT CONTROL NUMBER: 52-CC-20200220141637
FACILITY NAME:HERNANDEZ, MARIA DEL PILARFACILITY NUMBER:
434414668
ADMINISTRATOR:HERNANDEZ, MARIA DEL PILARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 704-6266
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 7DATE:
02/26/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Del Pilar HernandezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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PHYSICAL PLANT: Facility is dirty.
INVESTIGATION FINDINGS:
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LPA Dayna Collier met with licensee Maria del Pilar Hernandez for a complaint investigation regarding the above allegation. Present for the investigation were licensee, licensee's two adult daughters, licensee's daugther's fiance, licensee's assistant Blanca and 7 children in care consisting of 4 infants and 3 preschoolers. It was alleged that the facility is cluttered and in need of cleanliness. Per licensee's daughter, a large pick up was scheduled and alot of furniture and other items were recently removed from the facility. During the investigation, interviews were conducted which disclosed that licensee's home has been in need of cleaning due to the clutter. Today, the home is free of clutter. Licensee was informed that she must maintain her faciliity in the clean and healthy manner that she was originally licensed. Based on the LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number), are being cited on the attached LIC 9099D
See also attached LIC 9099C.
A SITE VISIT NOTICE WAS POSTED BY LICENSEE.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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 6
Control Number 52-CC-20200220141637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
VISIT DATE: 02/26/2020
NARRATIVE
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The attached type B deficiency is cited and must be corrected by the due date. This report must be available for public review for 3 years.
An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 52-CC-20200220141637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2020
Section Cited
CCR
102417(b)
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102417 Operation of a Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
This requirement was not met as evidenced by interviews conducted.
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POC: Prior to today's inspection, Licensee has cleaned and decluttered her home following a large pickup of items. Licensee ensures that she will maintain her facility in the manner that is clean and orderly.
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This poses a potential risk to the health and safety of children in care.
PRIOR TO LICENSEE'S RECENT CLEANUP AND PROCESS TO DECLUTTER HER HOME, THE HOME WAS NOT BEING MAINTAINED IN A CLEAN AND ORDERLY FASHION.
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2020 and conducted by Evaluator Dayna Collier
COMPLAINT CONTROL NUMBER: 52-CC-20200220141637

FACILITY NAME:HERNANDEZ, MARIA DEL PILARFACILITY NUMBER:
434414668
ADMINISTRATOR:HERNANDEZ, MARIA DEL PILARFACILITY TYPE:
810
ADDRESS:3181 BRYANT STREETTELEPHONE:
(650) 704-6266
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:14CENSUS: 7DATE:
02/26/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Del Pilar HernandezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
PERSONAL RIGHTS: Staff are handling day care children in an unsafe manner.
INVESTIGATION FINDINGS:
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LPA Dayna Collier met with licensee Maria del Pilar Hernandez for a complaint investigation regarding the above allegation. Present for the investigation were licensee, licensee's two adult daughters, licensee's daugther's fiance, licensee's assistant Blanca and 7 children in care consisting of 4 infants and 3 preschoolers. It was alleged that the changing table is not being sanitized and/or cleaned between diaper changes. In addition, one of licensee's assistants was observed carrying an infant under the arm in a way that did not appear an appropriate method. Per licensee, the changing table is cloth and is not changed after each diaper change. One of licensee's assistant admitted that she has carried an infant underneath her arm while she is reaching for something or carrying an additional item but denies that it was inappropriate. Licensee was informed that children's personal rights include offering a safe and comfortable environment. Based on the LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number), are being cited on the attached LIC 9099D. See LIC 9099C attached. A SITE VISIT NOTICE WAS POSTED BY LICENSEE.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 52-CC-20200220141637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
VISIT DATE: 02/26/2020
NARRATIVE
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The attached type B deficiency is cited and must be corrected by the due date. This report must be available for public review for 3 years.
An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 52-CC-20200220141637
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, MARIA DEL PILAR
FACILITY NUMBER: 434414668
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2020
Section Cited
CCR
102423(a)(2)
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102423 Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:
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POC: By 3/4/20, a written plan of action will be sent to Licensing detailing the diaper changing methods that are sanitary and the methods staff will use when carrying children.
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(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement was not as evidenced by interviews conducted and poses a potential risk to children in care.
METHODS USED I.E., DIAPER CHANGING AND CARRYING CHILDREN ARE NOT PROVIDING A SAFE ENVIRONMENT.
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6