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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845308
Report Date: 02/07/2025
Date Signed: 02/07/2025 01:30:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240815153246
FACILITY NAME:MUNOZ FAMILY CHILD CAREFACILITY NUMBER:
334845308
ADMINISTRATOR:MUNOZ,PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 259-7103
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:14CENSUS: 4DATE:
02/07/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Patricia Munoz, LicenseeTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Due to lack of supervision, child sustained an injury
INVESTIGATION FINDINGS:
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On 2/7/2025, at approximately 11:18 AM, Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Licensee Patricia Munoz and informed them on the purpose of this visit. During this investigation, the Department conducted interviews with staff and confidential witnesses, reviewed and obtained supportive documentation to assist in the determination of the findings in the above allegation.

The Department investigated an allegation that due to a lack of supervision; Child 1 (C1) sustained an injury. The investigation revealed that on 08/13/2024, at approximately 09:00 AM, C1 was playing on a plastic slide located in playroom adjacent to the living room.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
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 3
Control Number 10-CC-20240815153246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: MUNOZ FAMILY CHILD CARE
FACILITY NUMBER: 334845308
VISIT DATE: 02/07/2025
NARRATIVE
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The adjacent living room has a couch positioned out of direct eyesight to the slide in play area. Interview with Licensee confirmed that if an individual is seated on the couch, they are not able to observe children playing on the slide in the adjacent room.

During the investigation, Licensee was interviewed and admitted she was seated on the couch out of eyesight of the slide when she heard a child scream. Licensee rushed over to find C1 in the play area crying. Licensee stated C1 is non-verbal and was unable to tell Licensee what happened. Licensee brought C1 over to the couch to help calm C1 down. C1 began to calm down and was placed on a black circular chair in the center of the play area where the child began watching T.V. until they were tired. After C1s nap, around 10:00 PM – 12:00 PM, C1 did not appear to be feeling well. Licensee stated C1 was picked up by parent around 4:00pm. After parent picked up C1, they came back inside and asked if something was wrong with C1s arm because they started screaming as soon as it was touched. Licensee failed to tell parent about C1 screaming earlier in the day and told the parent they thought C1 was coming down with a “bug.” Parent informed Licensee they were taking C1 to the hospital due to the unusual behavior.

Additional information obtained was that C1 was taken for a medical evaluation on 8/13/24, after leaving the daycare. C1 was diagnosed with a “supracondylar fracture of left elbow.”

The responsibility of the licensee to ensure that children in care are supervised at all times was not met, resulting in a child sustaining an injury. Based upon interviews conducted, and evidence obtained, the preponderance of the evidence standard has been met, and the allegation is Substantiated.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Licensee Patricia Munoz along with copies of the LIC9099C, LIC811 (confidential names list), LIC9099D, and Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20240815153246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MUNOZ FAMILY CHILD CARE
FACILITY NUMBER: 334845308
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/08/2025
Section Cited
CCR
102417(a)
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102417 Operation of a Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. The requirement was not met as evidenced by:
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Licensee states they will provide a written letter stating how they will ensure appropriate supervision at all times. The correct will be submitted to the Department by (indicate POC date).
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Based on interviews conducted, and evidence obtained, on 8/13/24 Licensee did was not supervising children resulting in C1 sustaining an injury. This poses an immediate health, safety, or personal rights risk to children 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: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3