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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364843526
Report Date: 06/28/2023
Date Signed: 06/28/2023 11:52:41 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2023 and conducted by Evaluator Laura Mejorado
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230411142843
FACILITY NAME:DE ALBA FAMILY CHILD CAREFACILITY NUMBER:
364843526
ADMINISTRATOR:DE LA PAZ DE ALBA,AMARUCHYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 258-2290
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:14CENSUS: 1DATE:
06/28/2023
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Amaruchy De La Paz De AlbaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Adult in home caused injury to daycare child. (Personal Rights)

Uncleared adults residing in home. (Criminal Record Clearance)
INVESTIGATION FINDINGS:
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to deliver the findings of this complaint investigation which was initiated on 04/13/23. LPA met with Licensee, Amaruchy De La Paz De Alba. LPA toured the facility, took census, and discussed the following with the Licensee.

During the investigation, LPA made observations, reviewed pertinent documentation, and conducted interviews with pertinent parties.

It was alleged, adult in home caused injury to daycare child and uncleared adults residing in home.

LPA investigated the allegation and gathered the following information:

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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 3
Control Number 09-CC-20230411142843
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: DE ALBA FAMILY CHILD CARE
FACILITY NUMBER: 364843526
VISIT DATE: 06/28/2023
NARRATIVE
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Adult in home caused injury to daycare child:
It was reported a child’s authorized representative observed an injury to their child. Initially, it was reported to be a bruise but was later described as a burn mark on the child’s buttocks. While conducting interviews, the provider disclosed there was an allegation made against them by the subject child’s authorized representative regarding an injury to the subject child. The provider self-reported the incident with the authorized representative and to the Riverside Regional Office on 04/11/23. On the subject child’s last day of attendance on 04/04/23, the provider did not observe any bruises or burns on the subject child when changing their diaper, the subject child was observed to be “happy”. Provider indicated that if a child sustains an injury the child is checked out, first aid applied if needed, and the authorized representative is contacted immediately via phone and a picture is sent to the authorized representative. Provider also indicated they are a mandated reporter and if they would have observed something concerning, they would have reported it. Due to the age range of children, interview(s) with child(ren) did not reveal information that could be used to corroborate or neglect the allegation.

Uncleared adults residing in home:
It was reported there are three adults residing in the home who may not have a criminal record clearance. While conducting interviews it was disclosed there have been three adult relatives of the provider who have moved into the home from out of the country. The three adults were fingerprinted on 01/24/23 and 03/17/23 upon arrival but do not assist with the daycare. At the time of the initial inspection on 04/13/23, the three adults had cleared two levels of clearances, however; due to an error during the fingerprinting process, the third level was not submitted for clearance. The three adults were fingerprinted several more times, each time running into the same issues with the fingerprinting vendor not processing the request to obtain all three levels of service. As of today, all three adults residing in the home have a criminal record clearance. Based on the information obtained during this investigation, the licensee completed their due diligence by having the family members from out of the country fingerprinted upon arrival, however there were technical issues with the vendor.

Based on information obtained during this investigation through interviews conducted, the review of pertinent documentation, and after receiving conflicting information, the allegations are UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230411142843
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: DE ALBA FAMILY CHILD CARE
FACILITY NUMBER: 364843526
VISIT DATE: 06/28/2023
NARRATIVE
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An exit interview was conducted with the Licensee, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued.

The Notice of Site Visit (LIC 9213) shall be posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report must be made available for the next three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3