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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073409522
Report Date: 07/23/2024
Date Signed: 07/23/2024 01:50:49 PM

Substantiated


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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20240520133405

FACILITY NAME:HERNANDEZ, GLADYSFACILITY NUMBER:
073409522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 10DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Gladys HernandezTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Criminal Record Clearance - Uncleared adults are living in the home
INVESTIGATION FINDINGS:
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On July 23, 2024 at 9:11am Licensing Program Analyst (LPA) Indira Loza met with Licensee Gladys Hernandez for the purpose of conducting the complaint investigation for the above allegation. Present during the visit were four (4) school-age children, four (4) preschoolers, and two (2) infants, and the Licensee's child (over 10 years old). The Licensee left shortly after with four (3) school-age children. LPA toured the home for a health and safety check.

Interviews stated they have seen the Licensee's partner/husband, Julio Alvarez-Batres, in the home often and that he lives in the home. During both investigation inspections LPA saw an unidentified male who quickly left the home upon LPA's arrival. During the initial complaint inspection, LPA toured all areas of the home and observed male shoes and clothing, male cologne, and men's aftershave. The preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED. California Code of Regulations, Title 22 102370(d)(1) is being cited on the attached LIC9099-D with a Type A citation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 02-CC-20240520133405
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HERNANDEZ, GLADYS
FACILITY NUMBER: 073409522
VISIT DATE: 07/23/2024
NARRATIVE
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LPA informed Licensee Hernandez that this report dated 07/23/24 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the safety of children in care. LPA also informed the Licensee to provide a copy of this licensing report, dated 07/23/24 documenting two (2) Type A citations, 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 another written statement, must be placed in the child's file for verification.

See LIC809-D for the Type A deficiency.

Exit interview conducted.
Report and Appeal Rights provided to Licensee Gladys Hernandez.
Notice of Site visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 02-CC-20240520133405
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: HERNANDEZ, GLADYS
FACILITY NUMBER: 073409522
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2024
Section Cited
CCR
102370(d)(1)
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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as
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The Licensee shall send the LPA proof that Julio Alvarez was fingerprinted, no later than 7/24/2024.

The facility will be assessed in the amount of $500.
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evidenced by: Based on interviews, observations, and record reviews it was determined that the Licensee's partner, Julio Alvarez, has been residing in the home which poses an immediate risk to the health, safety, and personal right 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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7