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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376100043
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:39:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2023 and conducted by Evaluator Selina Siao
COMPLAINT CONTROL NUMBER: 51-CC-20230510125355
FACILITY NAME:MARTINS, JASON FAMILY CHILD CAREFACILITY NUMBER:
376100043
ADMINISTRATOR:JASON MARTINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-4160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:14CENSUS: 12DATE:
06/27/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Jason MartinsTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Care and Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/27/2023 at 11:35am, Licensing Program Analyst (LPA), Selina Siao conducted an unannounced inspection to deliver the above complaint finding. The initial inspection was conducted on 05/17/2023. Present at the home today is licensee, his wife Luani Chagas at the facility with 12 children including their own 2 children. There are 4 infants and 8 preschool age children at the facility today supervised by licensee and his wife/helper Luani Chagas. Appropriate ratio was observed during today's inspection.
It was alleged on 05/05/2023, a daycare infant (C1) sustained a broken right clavicle while in care due to neglect or lack of care and supervision. Licensee stated that C1 was crawling up against the wall to reach for his blanket that was hanged up against the wall, the infant used the wall to assist him up and reached for the blanket with his hand. C1 pulled the blanket down and fell on the carpeted floor with the blanket. Throughout the course of investigation department conducted interviews with other public agency member, medical provider, facility staff members and several day care parents. In addition, medical records were obtained and reviewed. Based on information gathered, there is no evidence to corroborate the alleged neglect/lack of care and supervision resulting in the day care child's injury. Therefore, the above allegation is deemed unsubstantiated. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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