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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334806175
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:00:11 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2021 and conducted by Evaluator Laura Mejorado
COMPLAINT CONTROL NUMBER: 09-CC-20210825083130
FACILITY NAME:SEYMOUR FAMILY CHILD CAREFACILITY NUMBER:
334806175
ADMINISTRATOR:SEYMOUR, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 322-0839
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:14CENSUS: 10DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Susan SeymourTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Personal Rights - Daycare child injured while in care.
INVESTIGATION FINDINGS:
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On 11/18/2021 Licensing Program Analysts (LPAs) Laura Mejorado and Samule Lopez arrived at the facility to conclude a complaint investigation which was initiated on 08/30/2021. LPAs met with Licensee Susan Seymour, toured the facility, took census, and discussed the following.

During the investigation, LPA made observations, reviewed pertinent documentation and conducted interviews with pertinent parties. During today’s inspection, LPA observed 10 children in care.

It was alleged, a daycare child was injured while in care.

LPA investigated the allegation and gathered the following information:

Please see LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 5
Control Number 09-CC-20210825083130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SEYMOUR FAMILY CHILD CARE
FACILITY NUMBER: 334806175
VISIT DATE: 11/18/2021
NARRATIVE
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It was reported, on or about 08/24/2021 during pick up, the Licensee “casually” informed a parent their child had been bitten by another daycare child. After arriving home, it was discovered the child had multiple bites on their arm, which broke the skin and caused bruising. Licensee stated they witnessed the children playing together and then “so fast” one child took “two chomps” out of the other child’s arm. Licensee admitted to witnessing “two chomps”; however, review of pertinent documentation (photos) showed the child sustained four bite marks. Licensee has a biting policy on file with biting notices for parents informing them of a biting incident. Interviews disclosed parents were only notified verbally during pick up. Other information obtained during the investigation revealed that the Licensee’s observation of “two chomps” was incorrect. In fact, the subject child was bitten four times, therefore the supervision and/or intervention provided by the Licensee was not sufficient enough to prevent the child from being bitten several times, resulting in the child’s personal rights being violated.

Based on LPAs observation of photos, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC9099D.

An exit interview was conducted with the Licensee, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

A copy of this report must be made available for the next three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 09-CC-20210825083130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SEYMOUR FAMILY CHILD CARE
FACILITY NUMBER: 334806175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2021
Section Cited
CCR
102423(a)(1)
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102423 Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee...(1) To be treated with dignity in his/her personal relationship with staff and other persons.
This requirement is not met as evidence by:
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Immediately, Licensee agrees to ensure children personal rights are not violated. Licensee agrees to update their biting policy and implement a plan to meet the needs of all children in care.
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Based on interviews and review of pertinent documentation (photos), Licensee was not sufficient enough to prevent the child from being bitten several times, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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The licensee will provide a written statement to Department by 11/19/21, listing what plan has been developed and how it will be carried out.
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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: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5