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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334842596
Report Date: 05/19/2023
Date Signed: 05/19/2023 09:34:25 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
05/17/2023 and conducted by Evaluator Giselle Carbullido
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230517130748
FACILITY NAME:RUBIO FAMILY CHILD CAREFACILITY NUMBER:
334842596
ADMINISTRATOR:RUBIO, JOANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 532-5782
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:14CENSUS: 0DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Joanna RubioTIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Facility staff did not provide required documentation to parent.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to investigate regarding the above complaint received on 05/17/2023. LPA was given access to the facility by Licensee, Joanna Rubio. LPA Carbullido discussed purpose of visit, took census, and toured the facility. LPA met with the Licensee to further discuss the complaint allegations and deliver findings.

It was alleged facility staff did not provide required documentation to parent. During the investigation, LPA reviewed records and conducted an interview with Licensee. Licensee interview acknowledged not giving out required documents (copy of report and deficiency) to parents for a type A citation from visit on 03/16/23.

Based on Licensee's own admission, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED per Health and Safety code 1596.8595(c). See LIC 9099D for deficiency cited.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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 09-CC-20230517130748
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: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 334842596
VISIT DATE: 05/19/2023
NARRATIVE
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 An exit interview was conducted with Licensee, Johanna Rubio and appeals rights were discussed. LPA Carbullido provided Licensee a copy of this report, appeal rights, and Notice of Site Visit form. LPA observed the Notice of Site Visit form was posted by Licensee. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 09-CC-20230517130748
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: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 334842596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited
HSC
1596.8595(c)
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1596.8595(c) A licensed ... home shall provide to the parent of each child receiving services ... 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 ....1596.893b This requirement is not met as evidenced by:
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Licensee provider is closing day care facility effective today's date 05/19/23. Written closure statement and surrender of license submitted during this viist.
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Based upon Licensee's own admission, facility did not provide required documentation to parents regarding type A citations from visit on 3/16/23. This is a potential health and safety risk to 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: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3