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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304312178
Report Date: 02/11/2022
Date Signed: 02/11/2022 11:23:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2021 and conducted by Evaluator Pat Rivas
COMPLAINT CONTROL NUMBER: 06-CC-20211130152903
FACILITY NAME:SILVA, HEMAMALIFACILITY NUMBER:
304312178
ADMINISTRATOR:SILVA, HEMAMALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 400-2268
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY:14CENSUS: 10DATE:
02/11/2022
UNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Day care child sustained injuries while in care
Licensee is retaliating against day care child's authorized representative for filing a complaint
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Rivas conducted a complaint visit to render findings for the above allegations. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance. A Facility Risk assessment was conducted to determine the level of Personal Protective Equipment (PPE) was needed for an on-site inspection. Licensee and assistants were wearing masks inside.
On 11/30/21 the Regional Office received a complaint alleging; 1) Day Care child Sustained injuries while in care 2) Licensee is retaliating against day care child’s authorized representative for filing a complaint.
The investigation consisted of; interview with licensee, and 4 families, review of facility records, including ring video.
In reference to the allegation that a day care child sustained injuries while in care; It was reported that child #1(C1) had sustained a scratch on the nceck & nose while in care. Licensee Silva denied that C1 sustained injuries while in care. Licensee reports that C1’s parents had notified Licensee in the evening via text that C1
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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 06-CC-20211130152903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SILVA, HEMAMALI
FACILITY NUMBER: 304312178
VISIT DATE: 02/11/2022
NARRATIVE
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scratch on the nose. Never mentioned about neck. Ms. Silva reports that when C1’s parents picked C1 up they did not notify her of the scratch on the nose. LPA observed ring video which shows C1 and C1’s parents walking to their car. At this point C1 was not wearing a mask. Ms. Silva stated C1’s parents could have advised her of injury at this point but did not. A review of the ring video shows C1did not have a mask on when walking to car. A review of 6 out of 6 children’s files and did not note injury report. Interview with 4 of 7 parents contacted indicated there were no issues or concerns with the home. LPA was unable to interview 3 of 7 parents, calls were not returned. LPA was unable to corroborate allegation.

In reference to the allegation that licensee is retaliating against day care child’s authorized representative for filing a complaint; Licensee Silva states she does not retaliate, she does not know for a fact who has filed complaints. Licensee stated she thought it may have been 1 of 2 families. Licensee states she believes both sets of parents were upset because she has been enforcing her COVID-19 Protocols, sending children home or not accepting them if the children had any COVID-19 symptoms. Interview with 4 of 7 parents indicate they have no issues or concerns with day care. LPA was unable to interview 3 of 7 parents, calls were not returned. LPA was unable to corroborate allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Licensee Silva. Appeal Rights were explained. The licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

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.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2