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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426215918
Report Date: 02/02/2022
Date Signed: 02/02/2022 03:25:30 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2021 and conducted by Evaluator Sylvia Mendoza-Ceja
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20211104143946
FACILITY NAME:FONSECA FAMILY CHILD CAREFACILITY NUMBER:
426215918
ADMINISTRATOR:YADIRA FONSECAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 757-1067
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 4DATE:
02/02/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Yadira FonsecaTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Day care child received a bruise while in care
INVESTIGATION FINDINGS:
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Today's inspection was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and G. Reyes. The purpose of today's inspection is to conclude the complaint initiated on 11/08/2021. Investigation included obtaining the complainant's statement interviewing the parents of children in care, and reviewing medical report for child #19. In addition, Licensee Yadira Fonseca self reported the incident to the Department on 11/04/2022.

-Parents of children in care current/former were interviewed did not corroborate any concerns about injuries while in day care. Parents stated they were satisfied with the care and supervision.
-Review of the medical report dated 12/6/2021 revealed child #19 was seen for a head injury, but was negative for any bruises on the head and examination was normal.

-Licensee Yadira Fonseca self reported the incident on 11/04/2021 to the Department as required when child #19 hit his forehead on the feeding table. Licensee stated she tried to apply ice on the area, but the child refused. Licensee stated she and parent communicated over text and requested the parent to pick up child #19. Licensee stated she never observed a bruise on child #19 forhead after the incident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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 17-CC-20211104143946
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FONSECA FAMILY CHILD CARE
FACILITY NUMBER: 426215918
VISIT DATE: 02/02/2022
NARRATIVE
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Although child #19 may have sustained a bruise there is no indication of a violation of CCR, Title 22, Division 12 occurred in day care. The above allegation is unsubstantiated, based on LPA observations, interviews with licensee, parents, complainant, and record review. Although these allegations may have occurred, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore, the allegation is unsubstantiated. An exit interview was conducted with the with the Licensee.

A copy of this report and appeal rights were discussed and left with the Licensee.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2