<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334845187
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:34:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/27/2023 and conducted by Evaluator Lorena Valenzuela
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20231127144023
FACILITY NAME:PETERSON FAMILY CHILD CAREFACILITY NUMBER:
334845187
ADMINISTRATOR:BRITTNEY PETERSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 534-3418
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:14CENSUS: 7DATE:
04/11/2024
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Brittney PetersonTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to lack of supervision child required immediate medical attention
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/11/2024, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the Peterson Family Child Care Home and met with licensee Brittney Peterson, to deliver the findings of the above allegation.
On 11/27/2023, the Department received the allegation due to lack of supervision Child 1 (C1) needed immediate medical attention. It was reported that on 11/17/2023, C1 was having health complications in regard to passing items through C1’s gastrointestinal tract due to ingested foreign items which included rocks/gravel and balloon/s.
On 12/01/2023, LPA Valenzuela conducted a health and safety inspection of the facility and obtained relevant documents. The investigation was conducted by Charlotte Jackson Investigator of the Community Care Licensing Investigation Branch (IB). The following pertinent documents were obtained: facility records, such as children’s roster, Riverside County Sheriff Department reports, and medical records for C1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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 10-CC-20231127144023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: PETERSON FAMILY CHILD CARE
FACILITY NUMBER: 334845187
VISIT DATE: 04/11/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During the investigation, confidential interviews revealed C1 had behavioral issues and required close supervision. Witness interviews revealed C1 attended the daycare on 11/17/2023. In addition, interviews revealed on 11/17/2023 or a day prior, a child (Child 2) brought balloons to the day care home and C1 and C2 were playing with the balloons while in care. Furthermore, interviews revealed C1 had been known to put sand in C1’s mouth while in the backyard area that consisted of sand, dirt and gravel at the time of the incident.

Based on the investigative evidence gathered by Investigator, Charlotte Jackson, the allegation due to lack of supervision Child 1 (C1) required immediate medical attention while in care, is substantiated. The facility is being cited under Title 22, Section 102417 (a) Operation of a Family Child Care home.

See deficiency report LIC 9099-D for citation issued.

An exit interview was conducted, and a copy of this report, LIC 811, LIC 9099-D, and appeal rights was provided to licensee Brittney Peterson. The Notice of Site Visit was also provided and must remain posted for 30 days.

LPA Lorena Valenzuela informed licensee, Brittney Peterson that this report dated 04/11/2024 documents a Type A citation and shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care. Additionally, LPA informed the licensee to provide a copy of this licensing report dated 04/11/2024, that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20231127144023
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: PETERSON FAMILY CHILD CARE
FACILITY NUMBER: 334845187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2024
Section Cited
CCR
102417(a)
1
2
3
4
5
6
7
102417 (a) Operation of a Family Child Care Home
The licensee shall be present in the home and shall ensure that children in care are supervised at all times…
This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee will provide a written plan of supervison to ensure children are supervised at all times, to the Department by due date 04/12/2024.
8
9
10
11
12
13
14
Based on interviews and records review, Licensee did not ensure Child 1 was supervised at all times on 11/17/2023, resulting in C1 ingesting several rocks/gravel and balloon/s while in care. This poses an immediate health, safety, or personal rights risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3