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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 243806059
Report Date: 07/29/2022
Date Signed: 07/29/2022 10:25:29 AM

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
07/19/2022 and conducted by Evaluator Priscilla Zamudio
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20220719083844
FACILITY NAME:DANA'S DAY CAREFACILITY NUMBER:
243806059
ADMINISTRATOR:HAUMEA, DANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 769-1293
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:14CENSUS: 7DATE:
07/29/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dana HaumeaTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Licensee did not report incidents of police involvement that occured during day care hours to CCL.
INVESTIGATION FINDINGS:
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On 7/29/22, Licensing Program Analyst (LPA) Priscilla Zamudio, and Licensing Program Manager (LPM) Diana De Leon arrived at the facility to conduct an unannounced complaint inspection. The purpose of the inspection was to deliver investigation findings. LPA explained the allegation to Licensee, Dana Haumea, and a census was taken. Licensee requested to note that incidents did not occur during daycare hours.

During the course of the investigation, LPA conducted an inspection, reviewed records, interviewed licensee and children. Based on information obtained, there is a preponderance of the evidence to prove the Licensee did not report incidents of police involvement; therefore, the allegation is SUBSTANTIATED.

Per California Code of Regulation, Title 22, Division 12, a deficiency is being cited (continued on page 9099 D). Exit interview conducted with Licensee. The licensee was provided a copy of their appeal rights. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
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 04-CC-20220719083844
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: DANA'S DAY CARE
FACILITY NUMBER: 243806059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2022
Section Cited
CCR
102416.2
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102416.2 Reporting Requirements
(d) The licensee shall report to the Department as provided by Health and Safety Code Sections 1597.467(b)(1) and (2).During interviews conducted and inforrmation gathered, it was determined
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Licensee stated she will call licensing for any future incidents and also provided a written statement indicating her understanding of this violation and how she will correct it in the future.
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 licensee did not report incidents of police involvement that occurred at this facility. This poses as a potential risk to the health, safety 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: Diana deLeon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2