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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 543802433
Report Date: 05/13/2022
Date Signed: 05/13/2022 02:33:09 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2022 and conducted by Evaluator Ruby Ocegueda
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220329132916

FACILITY NAME:ANNA'S DAY CAREFACILITY NUMBER:
543802433
ADMINISTRATOR:MENDEZ, ANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 784-0977
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:14CENSUS: 4DATE:
05/13/2022
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Anna MendezTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Licensee left daycare children in care of an unclear adult
INVESTIGATION FINDINGS:
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On 5/13/2022, Licensing Program Analyst (LPA) Ocegueda conducted an unannounced complaint inspection for the purposes of delivering the finding for the above-named allegation. LPA met with licensee Anna Mendez, toured the facility and took a census.

During the course of the investigation, LPA Ocegueda conducted interviews of Licensee, children, day care parent(s) and complainant and gathered facility records. Interviews revealed that licensee left children in care with adult #1 who does not have required criminal record clearance.

This agency has investigated the complaint allegations stating that Licensee left daycare children in care of an uncleared adult and determined that the complaint allegation was SUBSTANTIATED, meaning the preponderance of evidence standard has been met.

Per California Code of Regulation, Title 22, Division 12, Chapter 3, the following deficiency is cited (see LIC 9099-D). Report continued to page 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 04-CC-20220329132916
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: ANNA'S DAY CARE
FACILITY NUMBER: 543802433
VISIT DATE: 05/13/2022
NARRATIVE
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Report continued from previous 9099 page

An Exit interview was conducted with Licensee, Anna Mendez. A copy of this report and appeal rights were provided to Licensee.

LPA also reviewed and provided “Acknowledgment of Receipt of Licensing Form” (LIC 9224). Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Notice of Site Visit LIC 9213 and a copy of this report shall be posted for 30 days.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 04-CC-20220329132916
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: ANNA'S DAY CARE
FACILITY NUMBER: 543802433
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2022
Section Cited
CCR
102370(d)(1)
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(d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee stated she would not allow any uncleared adults to provide care and supervision at any time to children in care. Licensee will submit a written statement indicating her plan and understanding of the requirement to the Department by POC date 5/16/2022.
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This requirement was not met as evidenced by: interviews. Licensee left child #1, #2, #3 in the care of an uncleared adult (adult #1) on one occassion on approximately the month of March 2022. This poses/posed an immediate risk to the health, safety and or personal rights of 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: Michael Duarte
LICENSING EVALUATOR NAME: Ruby Ocegueda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5