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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364844734
Report Date: 04/21/2021
Date Signed: 04/21/2021 12:33:28 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2021 and conducted by Evaluator Jazelle Neal
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210302094524
FACILITY NAME:GONCALVEZ DE BROWN FAMILY CHILD CAREFACILITY NUMBER:
364844734
ADMINISTRATOR:GONCALVEZ DE BROWN, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 267-5010
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 3DATE:
04/21/2021
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Ana Gonvalvez De Brown TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Allegation 1 - Other: Uncleared adult providing care and supervision to daycare children.
Allegation 2 - Other: Provider not meeting daycare child’s diapering needs resulting in a diaper rash.
Allegation 3 - Personal Rights: Provider made inappropriate comments towards daycare child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Neal conducted a follow-up complaint investigation and met with licensee, Ana Gonvalvez De Brown via Tele-Inspection as directed by current Covid-19 procedures for the purpose of delivering complaint findings. During this investigation LPA interviewed children, staff and as well as reviewed pertinent documents.
Allegation #1: LPA Neal conducted interviews with staff and children regarding identity of Adult #1 and any interactions with day care children. Adult #1 was identified to be helping with contracting/repairs temporarily at the home which was confirmed by interviews with children. Adult #1 does not provide care and supervision to day care children. Allegation deemed unsubstantiated.
Allegation #2: LPA Neal conducted interviews regarding diapering protocol at the facility. Based on information gathered, a singular incident happened regarding misunderstanding in diaper change. It was determined that there was not enough evident to prove an
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Jazelle Neal
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
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 12-CC-20210302094524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GONCALVEZ DE BROWN FAMILY CHILD CARE
FACILITY NUMBER: 364844734
VISIT DATE: 04/21/2021
NARRATIVE
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allegation of not meeting needs or that diaper rash was a direct result. Based on information obtained, allegation is deemed unsubstantiated.
Allegation #3: LPA Neal conducted interviews with children and staff. Children interviewed made no disclosures about inappropriate comments made by licensee at the facility. Allegation deemed unsubstantiated.
A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged occurred.
Notice of Site Visit was given to be posted for 30 days.
Exit interview was conducted and a copy of this report was forwarded to the director via email for confirmation with “Read Receipt” on this date.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Jazelle Neal
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021
LIC9099 (FAS) - (06/04)
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