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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376600676
Report Date: 03/12/2024
Date Signed: 03/12/2024 01:15:50 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
03/04/2024 and conducted by Evaluator Keely Messerschmidt
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240304150402
FACILITY NAME:CASA DE NINOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
376600676
ADMINISTRATOR:RODRIGUEZ, ANAFACILITY TYPE:
850
ADDRESS:1718 MISSION AVENUETELEPHONE:
(760) 757-3207
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:117CENSUS: 48DATE:
03/12/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Ana RodriguezTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff did notify authorized representative of incident involving child.
INVESTIGATION FINDINGS:
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On the above date and time listed, Licensing Program Analyst (LPA) Keely Messerschmidt arrived at the facility for the purpose of delivering the complaint findings on the above-referenced allegation. LPA met with Director Ana Rodriguez. LPA toured the facility, conducted census, and verified facility staff and children enrollment. LPA discussed with Director the conclusion of the complaint investigation.

On March 4th , 2024, Community Care Licensing (CCL) received a complaint alleging that staff did notify authorized representative of incident involving child. In regard to the allegation, LPA Messerschmidt reviewed documentation and conducted interviews with the Director, staff and child and was able to corroborate these allegations.

See LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
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-20240304150402
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: CASA DE NINOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376600676
VISIT DATE: 03/12/2024
NARRATIVE
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Regarding allegation, staff did notify authorized representative of incident involving child, based on documentation received and interviews conducted it is was disclosed that an incident took place with Child #1, staff documented the incident on their Case Note Form and filed it away not informing authorized representative of incident. During interviews it was disclosed that Case Notes are used to document incidents where they inform authorized representatives and obtain a signature but also for documentation purposes. In this case it was confirmed that the incident was not communicated to C1s authorized representative.

Based on the information obtained during this investigation, it has been determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. Therefore, the allegations are SUBSTANTIATED.



An exit interview was conducted, and this report was reviewed with the Director, Ana Rodriguez, and a copy was provided. Appeal rights were discussed and provided during the exit interview.

A Notice of Site visit was given, and Director understands that it must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 10-CC-20240304150402
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: CASA DE NINOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 376600676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
101212(d)(1)(f)
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(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

This was requirement was not met as evidenced by,
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Director agrees to review regulation and create a plan on how they will ensure authorized represenatives are informed of incidents involving their child (ren) moving forward and will submit proof to LPA via email by 3/15/24.
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Based on record review and interviews, authorized representative was not notified of incident involving Child #1. This is a potential risk to the health and safety of children in care. 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: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3