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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700105
Report Date: 03/09/2022
Date Signed: 03/09/2022 09:43:26 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2022 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20220111135546
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
03/09/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Virginia MartinezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Allegation #1 Reporting Requirements: Licensee did not inform appropriate parties of positive COVID-19 cases on more than one occasion
INVESTIGATION FINDINGS:
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On March 09,, 2022, Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced complaint inspection on the above allegation. LPA disclosed the purpose of inspection and was granted entry by Assistant who guided LPA on a tour of the family child care home. During initial entry, Licensee was not present at the facility and 6 children were present. Licensee was conducting child pick ups and arrived at about 4.00 P.M.

Licensee disclosed to LPA of 2 positive Covid-19 cases passing the required reporting requirements. Also licensee did not report additional positive covid results on different occasions to parents and CCL. Based on observations, interviews conducted and documentation obtained, allegation:Licensee did not inform appropriate parties of positive COVID-19 cases, the preponderance of evidence standard has been met, therefore the above allegation is found Substantiated. California Code of Regulations, Title 22, Division 12 Reporting Requirements Operation of a Family Child Care Home Type B violation is being cited.
An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
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 2
Control Number 12-CC-20220111135546
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MARTINEZ FAMILY CHILD CARE
FACILITY NUMBER: 197700105
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/10/2022
Section Cited
CCR
102416.2(a)(b)
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(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).
(b) The licensee shall report to the Department any of the events as specified in Health and ...
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Licensee will report all unusual incidents (UIR) to the Palmdale RO by fax, mail or email within 7 days in writing-(UIR) and call within 24 hrs to report incident to the Officer on Duty.
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Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement was not met by interviews conducted and documentation(child##2 positive results) and disclosures. This posses a potential risk to 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: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC9099 (FAS) - (06/04)
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