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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 103909421
Report Date: 02/14/2023
Date Signed: 02/14/2023 10:59:52 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO-CC, 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
02/10/2023 and conducted by Evaluator Denisia Jimenez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20230210145816
FACILITY NAME:VALENZUELA, JAMIE FAMILY CHILD CAREFACILITY NUMBER:
103909421
ADMINISTRATOR:VALENZUELA, JAMIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 473-3685
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:14CENSUS: 10DATE:
02/14/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jamie ValenzuelaTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Licensee did not provide copies of required licensing reports to authorized representatives of day care children.
INVESTIGATION FINDINGS:
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On 02/14/2023, Licensing Program Analyst (LPA) Denisia Jimenez and Licensing Program Managers (LPMs) Juvenal Moctezuma and Cynthia Brannon conducted an unannounced complaint inspection to initiate and conclude the complaint investigation that was received on February 10, 2023. LPA met with Licensee, Jamie Valenzuela and discussed the purpose of the inspection and investigation findings. A Tour of the home was conducted and census were taken.

During the inspection, LPA obtained copies of the licensees children's roster and children's files. Through file review it was confirmed that licensee did not obtain a parent signature for the Acknowledgement of receipt of licensing reports LIC 9224 for Child #1.Based on the investigation conducted, it was determined that the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiency is being cited. (See LIC 9099D), Licensee was provided a copy of their appeal rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 04-CC-20230210145816
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: VALENZUELA, JAMIE FAMILY CHILD CARE
FACILITY NUMBER: 103909421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited
HSC
1596.8595(c)(1)
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(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b (3.) The licensee shall require each recipient of the licensing report described in paragraph (1) pertaining to a complaint investigation to sign a statement indicating that he or she has received the document and the date it was received.
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Licensee understands that she needs to provide LIC 9224 to all the children's parents and put the signed copy of the form in the children's files for the next 12 months from being cited a type A. Licensee will submit a written plan of correction stating how this will not happen again and submit a plan in place to make sure all the forms are signe by no later than 2/24/23..
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This requirement was not met as evidenced by LPA conducting a file review and licensee stating that they did not provide the licensing report or obtain a signature for form LIC 9224 from Child #1s parent.
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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: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2