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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483009483
Report Date: 08/31/2023
Date Signed: 08/31/2023 12:09:52 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2023 and conducted by Evaluator Elpidia Hernandez Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 01-CC-20230607100011
FACILITY NAME:HERNANDEZ, LORENA FCCHFACILITY NUMBER:
483009483
ADMINISTRATOR:HERNANDEZ, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 712-1498
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:14CENSUS: 8DATE:
08/31/2023
UNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Licensee Lorena HernandezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Uncleared adult is providing care and supervision to daycare children.
Licensee is not present in the facility the required amount of time.
Facility operating out of ratio.
Provider using inappropriate forms of discipline.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres conducted a subsequent complaint investigation visit with licensee for the purpose of delivering complaint investigation findings. It has been alleged; Uncleared adult is providing care and supervision to daycare children, Licensee is not present in the facility the required amount of time, Facility operating out of ratio, and Provider using inappropriate forms of discipline.

During the initial investigation an interview was conducted with the licensee, two children and assistant on 06/13/2023. Licensee reported, She and her partner have all the requirements to stay alone with children, and they will switch off to run errands and the person who stays will stay with a qualified assistant. Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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 01-CC-20230607100011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HERNANDEZ, LORENA FCCH
FACILITY NUMBER: 483009483
VISIT DATE: 08/31/2023
NARRATIVE
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Licensee reported she attempted to hire an adult (A1) and took them to get fingerprinted but when A1 couldn’t get clearance licensee did not move forward with the process. Licensee provided LPA with copy of clearance letter for A1, showing A1 was granted background clearance 05/21/2023. Licensee reported when she hires someone, she gets them fingerprinted and all their certifications before they begin working in the home. Licensee also revealed as a large family childcare home she has 14 children enrolled but the children are on different schedules based on school and their vacation days. The licensee reported she disciplines children by placing them on a time out. Licensee did report she will speak firm to the children but has never used an inappropriate form of discipline. Interviews revealed A1 was working in the home earlier this year. One interview reported A1 was working in the home for a few months between April and May.One interview couldn’t remember how long A1 was working but remembers seeing A1 the last few weeks of May. Another interview revealed A1 was working but not for very long and couldn’t remember the dates. Interviews revealed the primary providers are the licensee and her partner but there are times when licensee leaves and children are left under the care of partner and qualified assistant. Both children reported there has been at least one occasion where Licensee had left and the children were under the care of A1 and qualified assistant. Interviews reported when the licensee leaves, she is usually running errands but is never gone for more than an hour. One child reported there are about 4-5 children in the morning and in the evening about 10-12 children present. Both children reported, both licensee and partner discipline in the same manner by placing children on time out.

Interviews were conducted with three guardians (G1-G3) and one Adult (A1) between 08/28- 08/30. One guardian remembered A1 working at the day care but couldn’t remember the dates. Other guardian interviews revealed the primary providers are License, her partner, and two other women but couldn’t remember the other women’s names. A1 reported they worked in the home as a house cleaner for a few months earlier this year but would arrive as the day care was closing and couldn’t remember the exact dates they were in the home. A1 reported they did not take care of the children as it was always Licensee and her partner who were running the day care. A1 also reported there were few times when they arrived, and licensee left but would return before A1 left. All interviews corroborated in the evening both licensee and partner were supervising about 4-5 children. Some guardians reported when they arrived licensee was almost always there, and when she wasn’t home she would arrive shortly before the guardians left with their children. One guardian corroborated, reporting when they arrive to pick up their children it was always licensee or her partner who released the children to them. All interviews revealed licensee disciplines the children by placing them on a time out. Continued on 9099-C.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20230607100011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HERNANDEZ, LORENA FCCH
FACILITY NUMBER: 483009483
VISIT DATE: 08/31/2023
NARRATIVE
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Based on interviews conducted and records reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegations are Unsubstantiated.

This report was reviewed and discussed with licensee. She was provided with a copy of this CIR; and Appeal Rights. All licensing reports are public information and must be made available upon request for at least three years. There were no Title 22 deficiencies cited during today’s inspection.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3