Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376624202
Report Date: 03/18/2016
Date Signed 03/18/2016 01:52:11 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2016 and conducted by Evaluator Mary A Richards
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20160317080354
FACILITY NAME:HIBBERT, BARBARA FAMILY CHILD CAREFACILITY NUMBER:
376624202
ADMINISTRATOR:BARBARA HIBBERTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 761-9982
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 5DATE:
03/18/2016
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Barbara HibbertTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Other-Uncleared adult residing at the facility: Christian "Chris" Davis, licensee's adult cousin, has been residing at the facility for several months without a criminal record clearance/exemption.

Record Keeping-The licensee failed to maintain children's form/records for 2 children in care

Reporting- Licensee failed to report an unusual incident to the department that occurred on or about 3/15/16.
INVESTIGATION FINDINGS:
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LPA Angel Richards arrived at the facility to conduct an unannounced Complaint Visit for the purpose of investigating the above allegations. There were 5 children in care with the licensee, licensee's son, and helper Shanise Williams. Upon arrival LPA observed a male in the open garage. The male rushed into the home leaving the garage open. LPA toured the facility with the licensee. Once the licensee opened the bedroom door to one of the off limits rooms LPA observed the same male on the bed with his face and upper body covered by a pillow. LPA also observed several of his items in the bedroom and interviewed the licensee. LPA requested the files for child #1 & #2 which were not availiable for review. Based on the above the preponderance of the evidence standard has been met, therefore the above allegations are found to be Substantiated. See attached LIC 9099D for the deficiencies cited. The licensee was provided a copy of the Appeal Rights and her signature on this form acknowledges receipt of these rights. The facility is required to provide a copy of this report to the parents/guardians of all children currently in care as well as the parents/guardians of any children newly enrolled over the next year. Parents/guardians are to sign form LIC 9224 and the form is to be kept in each child's file for Licensing review. In addition, this report must be posted along with the Notice of Site Visit for 30 days. LPA observed the posting during the visit.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Mary A RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2016
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 20-CC-20160317080354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HIBBERT, BARBARA FAMILY CHILD CARE
FACILITY NUMBER: 376624202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2016
Section Cited
102370(d)(1)
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Criminal Record Clearance: All individuals subject to a criminal record review prior to working, residing or volunteering in a licensed home, shall obtain a CA clearance or a criminal record exemption as required by the Department. Licensee's cousin Christian Davis has been residing in the home without a criminal record clearance/exemption.
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Mr. Davis left the facility during the visit. Licensee will submit proof of all of his items removed from the home to the licensing agency by 3/19/16. Mr. Davis will not return to the home unless a criminal record clearance/exemption is obtained.
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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.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Mary A RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2016
LIC9099 (FAS) - (06/04)
Page: 2 of 3


Control Number 20-CC-20160317080354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HIBBERT, BARBARA FAMILY CHILD CARE
FACILITY NUMBER: 376624202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2016
Section Cited
102421
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Child's Records: The licensee was unable to provide the records for child #1 & 2 during this visit. The children are no longer in care however the licensee is required to keep the children's records for 3 years.
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Licensee explains that the records are with her tax preparer. Child #1 & 2 are no longer in care. Nothing further is needed.
Type B
04/01/2016
Section Cited
102416.2(b)
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Reporting Requirements: The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. Licensee failed to report an unusual incident that occurred on or about 3/15/16.
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Licensee will submit the written UIR to licensing by 4/1/16.
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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.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Mary A RichardsTELEPHONE: 619-767-2208
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2016
LIC9099 (FAS) - (06/04)
Page: 3 of 3