Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304312394
Report Date: 07/02/2018
Date Signed 07/02/2018 02:32:25 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2018 and conducted by Evaluator Adrian Cortez
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20180405084505
FACILITY NAME:HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTOFACILITY NUMBER:
304312394
ADMINISTRATOR:AREVALO ESPERANZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 415-9125
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:14CENSUS: 9DATE:
07/02/2018
UNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Ascension Hernandez-ArevaloTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff member inappropriately handled day care child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cortez conducted a follow-up complaint investigation at the facility on today's date due to the allegation of staff member inappropriately handled day care child. The investigation was conducted in Spanish. The LPA met with the licensee, Ascension Hernandez-Arevalo, and announced the purpose for the investigation. The LPA toured the facility with the licensee. The licensee's assistants, Mariela Colina and Ana Velasquez, were present and assisting with the child care during today's investigation. Census was taken and there were nine children (ages two years old to eight years old) with the licensee and her assistants. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's investigation, the LPA delivered the findings of the complaint investigation.

Report continued on next page
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Adrian CortezTELEPHONE: 714-703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2018
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 06-CC-20180405084505
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTO
FACILITY NUMBER: 304312394
VISIT DATE: 07/02/2018
NARRATIVE
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Regarding the allegation of staff member inappropriately handled day care child, there was insufficient information revealed through the interviews of adults and children to corroborate the allegation. Additional children, including subject child, were unable to be interviewed by the LPA for the investigation due to not being able to communicate because of their age, and unavailability for being interviewed.

Based on information gathered through interviews, while the allegation may have happened or invalid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights explained. A copy of their appeal rights (LIC 9058) was given and signatures on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The first level appeal is to regional manager; address is above on the report. Exit interview was conducted.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Adrian CortezTELEPHONE: 714-703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 2