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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700475
Report Date: 05/20/2022
Date Signed: 05/20/2022 11:26:05 AM

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
05/02/2022 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20220502082013
FACILITY NAME:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700475
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Edna SerranoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Uncleared Adult
INVESTIGATION FINDINGS:
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On 5/20/2022 Licensing Program Analyst Carol Heath conducted an unannounced follow-up complaint investigation at the Serrano Family Child Care and met with Licensee Edna Serrano. The purpose of the visit is to deliver the complaint finding for the above allegation. That the facility has uncleared adult during the operation hours. During today's inspection, LPA observed 5 Day Care Children present and 1 Staff.
During the course of the investigation, interviews were conducted with Licensee, Licensee’s 2 children, Licensee’s mother, and other related parties (See LIC 811) Confidential Names List date 5/12/2022.
Based on the information obtained, there is a preponderance of the evidence to prove that the licensee fails to obtain a California clearance or a criminal record exemption. Therefore, the above allegation is substantiated. Appeal Rights were provided and discussed with the licensee and deficiencies were cited.
In addition, 4/14/2022, the licensee received LIC421BG Civil Penalty for uncleared adult in the facility. This will be the repeat violations

An exit interview was conducted, and A copy of this report was discussed and left with Licensee Edna Serrano
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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-20220502082013
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: SERRANO FAMILY CHILD CARE
FACILITY NUMBER: 197700475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2022
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 or This requirement is not met as evidenced by:
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The licensee will have her son complete the Livecan and send the documentation to the LPA.
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons 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: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
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