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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 243910980
Report Date: 05/12/2021
Date Signed: 05/19/2021 02:03:42 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2021 and conducted by Evaluator Caroline Harris
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210405095952
FACILITY NAME:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243910980
ADMINISTRATOR:HERNANDEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-0174
CITY:SANTA NELLASTATE: CAZIP CODE:
95322
CAPACITY:14CENSUS: 3DATE:
05/12/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria HernandezTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Day care provider(s) did not adequately supervise children in care.
INVESTIGATION FINDINGS:
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On 5/12/21, Licensing Program Analyst (LPA) Caroline Harris conducted a telephone call with Licensee, Maria Hernandez in order to close the above complaint investigation. Due to the COVID-19 pandemic, no one is available to conduct an in person visit to close this complaint. The investigation consisted of interviews with the licensee, parents, Resource and Referral program staff, County Social Worker, as well as a facility records review.

Based upon information and interviews conducted, the preponderance of the evidence standard has been met, therefore the above allegation is found to be substanuated.

California Code of Regulations, Title 22, Division 12, Chapter 3, are being cited on the attached LIC 9099D. An exit interview was conducted with licensee, Maria Hernandez via telephone call. A copy of this report was e-mailed to the licensee, Maria Hernandez who was asked to sign the report and send a copy back to the Fresno CCL office.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
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 04-CC-20210405095952
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243910980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2021
Section Cited
CCR
102417(a)
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Operation of a Family Child Care Home . The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement was not met as evidenced by inappropriate behavior
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The licensee agrees to review the training video on "Supervising Children in Family Child Care" on the CCL website and write a statement that she understands the requirements and what the requirements are.
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taking place between two day care children due to the licensee not appropriately supervising the children in care. This is a possible risk to the health, safety or personal rights of children in care.
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This statement will be sent in to the Fresno CCL office by the due date of 5/21/21.
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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: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2