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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019583
Report Date: 08/04/2023
Date Signed: 10/06/2023 08:46:33 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2023 and conducted by Evaluator Roxana Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20230712120259
FACILITY NAME:CORTEZ FAMILY CHILD CAREFACILITY NUMBER:
198019583
ADMINISTRATOR:ERICA CORTEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 399-8835
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:14CENSUS: 8DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Erica Cortez TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Child sustained injury while in care-broken femur on his right leg
INVESTIGATION FINDINGS:
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----------------------------------------This is an Ammended Report -------------------------------------------------------Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced follow-up complaint inspection to deliver findings on the above allegation. A COVID risk assessment was conducted upon entry. LPA met with Licensee, Erica Cortez, to whom the reason for the visit was explained. Census was taken.

During this investigation, interviews were conducted with staff, children, and parents by Investigations Branch (IB) investigator, Edward Hector. Investigator Edward also obtained several documents related to the complaint allegation.

This agency has investigated the complaint alleging child sustained injury while in care-broken femur on his right leg. Based on the information gathered and interviews conducted, the preponderance of the evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.
---------------------------------------------------------- pg.1 of 2--------------------------------------------------------------------------
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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 33-CC-20230712120259
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CORTEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019583
VISIT DATE: 08/04/2023
NARRATIVE
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------------------------------------------------------ This is an Ammended Report -------------------------------------------------
Though the allegation is substantiated incident was deemed to be an accident and therefore no deficiencies are being cited. Licensee was within the required ratio/capacity limitations.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee Erica Cortez.

------------------------------------------------------ pg. 2 of 2 ----------------------------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2