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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493735
Report Date: 02/16/2023
Date Signed: 02/16/2023 09:46:19 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2023 and conducted by Evaluator Tiffanie Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20230125145339
FACILITY NAME:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197493735
ADMINISTRATOR:VAZQUEZ,DIEGO/VAZQUEZ ASHLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 245-4344
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY:14CENSUS: 1DATE:
02/16/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Silvia Avalos MorenoTIME COMPLETED:
10:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights- A child sustained injury while in care due to lack of proper care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), T Tran arrived at the above licensed facility to conduct an unannounced subsequent complaint inspection for the purpose of concluding the investigation of the above allegation.
Upon arrival, LPA met with Licensee Silvia Avalos Moreno and observed a child in care.
Based upon the evidence obtained during the course of the investigation through interviews, and record reviews on 12/12/2022, C1 tripped over a toy car and sustained a red mark below the left eyebrow. On 1/12/2023, C1 tripped over a toy and hit the face on the toy shelve. Child sustained a red bruise near the lower left eyelid. Parent was contacted for both incidents and document of incidents were provided. Per parent, both incidents did not require medical attention. Licensee stated, she witnessed both incidents occurred, and proper care was provided, therefore the evidence does not support, nor disprove the above allegation was the result of lack of proper care occurred at the facility. Therefore, the allegation has been determined unsubstantiated. Unsubstantiated – A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Silvia Avalos Moreno.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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