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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525407993
Report Date: 01/13/2023
Date Signed: 01/13/2023 12:06:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/05/2023 and conducted by Evaluator Bianca Mendez
COMPLAINT CONTROL NUMBER: 13-CC-20230105153022
FACILITY NAME:RIVERA, ANGELICA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525407993
ADMINISTRATOR:RIVERA, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 875-0912
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY:14CENSUS: 3DATE:
01/13/2023
UNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Angelica RiveraTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee left minor alone to care for daycare children
INVESTIGATION FINDINGS:
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On 1/13/22 at 10:11am , Licensing Program Analyst (LPA) Mendez conducted an unannounced complaint inspection, and met with licensee. It was alleged that licensee left minor alone to care for daycare children..

The licensee was interviewed at 10:55am and denied the allegation and stated that she would never do that. She stated that she was closed from December 22, 2022 to January 6, 2023 and re opened her daycare on January 9, 2023.

During today’s inspection facility was toured, 12 children's files were reviewed and one staff file was reviewed. LPA observed at 10:11am that licensee was not present and child (C1) and (C2) were under the care and supervision of a minor (M1). LPA Mendez obtained of children's emergency contact information and requested the roster.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
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 13-CC-20230105153022
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: RIVERA, ANGELICA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525407993
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2023
Section Cited
HSC
1597.58(C)(2)
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(c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, for any of the following serious violations:

(2) Absence of supervision, including, but not limited to, a child left unattended and a child left alone with a person under 18 years of age.
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The Licensee agrees to send in a written plan and will be present at all times. A written plan will be submitted by 1/13/22 at 5pm to LPA Mendez

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This requirement is not met as evidenced by: based on observations and interviews, the the licensee did not meet the requirement, LPA observed C1 and C2 were left under the supervision of a minor (M1).This poses a immediate (type A) health and safety risk to the 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: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3