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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304312536
Report Date: 05/06/2021
Date Signed: 05/06/2021 03:47:47 PM

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
02/23/2021 and conducted by Evaluator Sherene Hawkins
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20210223110402
FACILITY NAME:BARAJAS, ANGELICAFACILITY NUMBER:
304312536
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/06/2021
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Angelica Barajas TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Lack of Supervision
INVESTIGATION FINDINGS:
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Tele-Inspection- COVID-19 State of Emergency
Licensing Program Analyst (LPA) Hawkins conducted a follow up investigation regarding a complaint of lack of supervision allegation which was initiated on 3/02/21. The purpose of this visit was to provide the complaint findings to licensee, Angelica Barajas. During today’s tele-visit (face time) a virtual visit a tour of the home was conducted. Present was the licensee who was caring for five day-care children. A review of criminal clearance records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 2/23/21 the Department received a complaint alleging lack of supervision resulting in children in care sustaining injuries. During the investigation, LPA interviewed licensee, three parents, two children, and reviewed facility records.

***continued on page 2***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021
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 06-CC-20210223110402
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: BARAJAS, ANGELICA
FACILITY NUMBER: 304312536
VISIT DATE: 05/06/2021
NARRATIVE
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Licensee reported that Child #1 (C1) was bitten by another child while being supervised, and another incident where licensee was tending to another child’s needs when Child #2 (C2) started combing their hair which then got tangled in the comb.
Licensee reports that the C2’s sibling initially tried to assist C2 along with licensee in removing the comb from the hair and as a result there was a substantial amount of hair loss due to child pulling the comb. In both incidents’ licensee stated they were both accidents, she was in close proximity to the children, she provided first aid and reported incidents to the parents immediately and sent pictures. Children interviewed reported that licensee is always close watching the kids, and if any child gets hurt its an accident. The two children involved in the incidents were not qualified for interviewing due to their age and developmental level. Parents interviewed were satisfied with the care and supervision provided to the children and had no concerns.

This agency has investigated the complaint alleging a lack of supervision resulting in injury to children. We have found that the complaint was unsubstantiated. While the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.



Exit interview was conducted. The report was read and reviewed with the licensee. A copy of the report, and their appeal rights (LIC 9058) will be emailed to Licensee with a Read Receipt requested to acknowledge report was received. Licensee was asked to respond to email by copying and pasting “I have read and received the Investigation Report, I acknowledge receipt.” Investigation Report LIC 9099 will also be mailed if those options are not available. First level appeals should be sent to the regional manager to the address listed above. All appeals must be in writing and received by the licensing office within 15 business days. The first level appeal is to regional manager.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Sherene Hawkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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