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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426211932
Report Date: 05/03/2023
Date Signed: 05/03/2023 09:46:06 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2023 and conducted by Evaluator Maryrose Breault
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20230209100807
FACILITY NAME:BERNAL FAMILY CHILD CAREFACILITY NUMBER:
426211932
ADMINISTRATOR:TOMASA BERNALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 562-8124
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 2DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Maria and Tomasa BernalTIME COMPLETED:
09:52 AM
ALLEGATION(S):
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Neglect/Lack of Supervision
INVESTIGATION FINDINGS:
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On May 3rd, 2023, at 8:38AM, Licensing Program Analyst (LPA) Rosie Breault made an unannounced inspection to the aforementioned Family Child Care Home (FCCH) in order to deliver the findings and complete the investigation of the above allegation. LPA met licensees Maria and Tomasa Bernal and at the time of the inspection there were two (2) children and two (2) staff.

The allegation of neglect/lack of supervision that a child was injured in care was fully investigated by Jose Santana and Sonia Sandoval, investigators within CCLD’s Investigation Bureau (IB) The IB investigation included observations, review of medical records and imaging, interviews with licensee, parents, physician, and facility client. In addition, relevant photos, text messages, ring imaging, and home videos were reviewed. Based on the investigation, it could not be proven injury happened in the FCCH. Furthermore, there is insufficient evidence to prove licensee neglect. The IB determined allegation of Neglect/Lack of Supervision is UNSUBSTANTIATED.

An exit interview was conducted, copy of report provided to licensee.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2023 and conducted by Evaluator Maryrose Breault
COMPLAINT CONTROL NUMBER: 17-CC-20230209100807

FACILITY NAME:BERNAL FAMILY CHILD CAREFACILITY NUMBER:
426211932
ADMINISTRATOR:TOMASA BERNALFACILITY TYPE:
810
ADDRESS:48 MENDOCINO DR.TELEPHONE:
(805) 562-8124
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:14CENSUS: 2DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Maria and Tomasa BernalTIME COMPLETED:
09:52 AM
ALLEGATION(S):
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9
Personal Rights
INVESTIGATION FINDINGS:
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On May 3rd, 2023, at 8:30AM, Licensing Program Analyst (LPA) Rosie Breault made an unannounced inspection to the aforementioned Family Child Care Home (FCCH) in order to deliver the findings and complete the investigation of the above allegation. LPA met licensees Tomasa and Maria Bernal and at the time of the inspection there were two (2) children and two (2) staff present.

The Department obtained an allegation that licensee did not notify parents of a child’s injury. On 2/16/2023, LPA interviewed co-licensees Tomasa Maria Bernal who indicated that she was aware of the Departments policy of reporting unusual incidents the following day of the incident. She also indicated she was aware parents have personal rights and has provided them the paperwork that indicates so. LPA asked if she, at any time, requested a parent not contact CCLD regarding an unusual incident that occurred. Tomasa stated, “not exactly” but that if the parent’s are to report the incident to licensing, she will have to although she did not believe the incident occurred at the FCCH. Per Maria, a mother of a child involved in an unusual incident stated she “had a friend who suggested I (mother) report it (incident) to licensing.” Maria responded “is fine, but you don’t trust me – take your babies home. Give your time to find someone else.” In addition, Tomasa stated “but I don’t want to happen and go to licensing.” Parent stated in interview Tomasa said, “she would prefer we don’t we report to licensing” and that parents tried to get licensees to report it to licensing; however, “if you are putting the ball in our court, we won’t report it.”
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 17-CC-20230209100807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: BERNAL FAMILY CHILD CARE
FACILITY NUMBER: 426211932
VISIT DATE: 05/03/2023
NARRATIVE
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Based on interviews conducted, and documentation reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Type B violation has been cited.

An exit interview was conducted in which licensees both were advised of parental personal rights and reporting requirements. Copy of report and appeal rights provided to licensee.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 17-CC-20230209100807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: BERNAL FAMILY CHILD CARE
FACILITY NUMBER: 426211932
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2023
Section Cited
CCR
102419(a)(2)
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Parents Rights....To file a complaint against the licensee with the local licensing office in accordance with Health and Safety Code Section 1596.853.
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POC – Licensees to view Parents’ Rights in Child Care at https://ccld.childcarevideos.org/parents-and-families/parent-rights-in-child-care/
Licensees to provide written plan of compliance based on the video to LPA Maryrose Breault at 6500 Hollister Ave Suite 200 Goleta CA 93117, no later than May 16th, 2023.
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This evidence is met by…. Licensee Maria Bernal statement, and interviews with parents
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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: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4