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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364845824
Report Date: 03/24/2023
Date Signed: 03/24/2023 04:16:16 PM

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
02/16/2023 and conducted by Evaluator Aman Sharma
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20230216124504
FACILITY NAME:BUBELLO FAMILY CHILD CAREFACILITY NUMBER:
364845824
ADMINISTRATOR:BUBELLO,BARBARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 549-4594
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:14CENSUS: 8DATE:
03/24/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Barbara BubelloTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Day-care child sustained an injury while in care.
Staff used an inappropriate form of discipline towards day-care child.
INVESTIGATION FINDINGS:
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On the date and time listed above, Licensing Program Analyst (LPA) Aman Sharma arrived at the facility to conclude an investigation regarding the above allegations to a complaint received on 02/16/2023. A previous inspection was conducted on 02/23/2022. LPA was given access to the facility by the licensee, Barbara Bubello. LPA discussed purpose of visit and toured the facility. LPA met with the licensee to further discuss the complaint allegation and deliver findings.

During the investigation, LPA interviewed pertinent parties, made observations and collected facility documentation. It was reported that a day-care child sustained an injury while in care, and staff used an inappropriate form of discipline towards day-care child.

The following information was collected during the investigation:

SEE 9099C.........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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 5
Control Number 09-CC-20230216124504
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: BUBELLO FAMILY CHILD CARE
FACILITY NUMBER: 364845824
VISIT DATE: 03/24/2023
NARRATIVE
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 ****AMENDED ON 06/01/2023****
LPA spoke with pertinent parties and gathered documents. It was alleged that a day-care child sustained an injury while in care and staff used an inappropriate form of discipline towards day-care child. During interviews with pertinent parties and through licensees own admission, on or about 02/14/2023, a child was refusing to take a nap. While the child started to throw a tantrum, the child was put in the back on-limits room, where they were placed to calm down by themselves, while the other children were put down for naps. When the subject child ran back out of the room, the child was then taken back into the room and the door was closed. Although the lock was on the inside of the door, the child was put back there with the door closed as a form of discipline for throwing a tantrum during naptime.

During this time, the subject child was able to knock off a television sitting on top of a night stand that stood between 2-3 feet tall. It was noted by facility staff that the child had a little cut on the bridge of their nose, which was not there before the child was dropped off that day. While the subject child was in the room with the door closed, facility staff were able to view it in "real-time" on their phone due to there being a camera in the room.

Based on LPAs interviews, licensees own admission, and other information obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 12) are being cited on the attached LIC9099D.

An exit interview was conducted with the Licensee, Barbara Bubello. 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 09-CC-20230216124504
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: BUBELLO FAMILY CHILD CARE
FACILITY NUMBER: 364845824
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/2023
Section Cited
CCR
102423(a)(2)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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IMMEDIATELY licensee will make sure that there are no inappropirate forms of discipline being used and that children are in a safe environment. LIcensee plans to hire additional staff to ensure proper supervision and assistance with children in care. Licensee will submit written proof of the POC no later than the POC due date.
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This requirement was not met as evidenced by: Facility staff did put the subject child in an unsafe situation, resulting in the subject child hurting themselves by getting a scratch on the bridge of their nose, resulting in a violation of a child's personal rights. This poses an immediate health and safety risk to children in care.
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***An office conference will be schedueld in the near future to discuss the incompliance of these violations.***
Type A
03/27/2023
Section Cited
CCR
102423(a)(4)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation
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IMMEDIATELY, licensee will make sure that there are no inappropirate forms of discipline being used and that children are in a safe environment. LIcensee plans to hire additional staff to ensure proper supervision and assistance with children in care. Licensee will submit written proof of the POC no later than the POC due date.
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ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by: Facility staff put the subject child in a room by themselves as a form of >>>
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***An office conference will be schedueld in the near future to discuss the incompliance of these violations.***

punishment, resulting in a violation of a child's personal rights. This poses an immediate health and safety risk to children in care.
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: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 09-CC-20230216124504
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: BUBELLO FAMILY CHILD CARE
FACILITY NUMBER: 364845824
VISIT DATE: 03/24/2023
NARRATIVE
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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 upon request for the next three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5