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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191226432
Report Date: 01/18/2022
Date Signed: 01/18/2022 03:04:13 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2021 and conducted by Evaluator Anomeh Eivazian
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211214152757
FACILITY NAME:SUSANNA WESLEY CHILDREN'S CTR/INFANTFACILITY NUMBER:
191226432
ADMINISTRATOR:ANTONETTE DATUINFACILITY TYPE:
830
ADDRESS:134 N. KENWOOD ST.TELEPHONE:
(818) 548-6229
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:19CENSUS: 0DATE:
01/18/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Morena Duran, DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is in disrepair
Staff commingle day care children
Facility is operating out of ratio
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Anomeh Eivazian and David Kurdoglyan conducted an unannounced complaint inspection to the above facility for the purpose of delivering the complaint findings. LPAs arrived at 12:30 p.m. on 01/18/2022 and met with Morena Duran, director who guided analyst on a tour of the facility. During this inspection there were 0 infants in the facility. Facility was closed due to Covid-19 positive exposures. There is a preschool program in the facility address with facility number 191204631.

During this investigation, LPA Eivazian conducted interviews with staff. Also LPA obtained a copy of facility roster and sign in /out sheet from 11/01/2021 to 12/20/2021.

Based on interviews that were conducted with staff#1, #4, #5, and #6, early in the mornings between 7:30 a.m. and 8:30 a.m. there were only staff#4, who is fully qualified infant teacher, staff#5 and staff#6 who are preschool teacher assistants with about 10 to 16 children (infants and preschoolers) and all the children commingle together in the infant classroom.
REPORT CONTINUES ON NEXT PAGE 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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
Control Number 33-CC-20211214152757
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 01/18/2022
NARRATIVE
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Based on staff interviews, there is a leak in the hallway of entrance, that children only transpass to walk to the classrooms and it was reported to the church to be fixed.

Based on LPA’s staff file reviews on 12/20/2021, staff#4 is a fully qualified infant teacher and staff #5 and staff#6, are preschool teacher assistants. LPA reviewed infant and preschool programs sign in/out sheets from 11/01/21 to 12/20/21 and observed in different days there were about 13 to 25 children (infants and preschoolers) present in the facility between 7:30 a.m. and 8:30 a..m..

LPA observed a leak mark on the ceiling in the hallway of entrance. Pictures were taken.

Based on LPA’s observations and interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated at this time. California Code of Regulations: 101416.5 (b)-- Staff-Infant Ratio-- There shall be a ratio of one teacher for every four infants in attendance. 101238(a)-- (a)--The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors, and 101538.3 (b)-- Indoor Activity Space for School-Age Children were cited during this inspection.



LPA Anomeh Eivazian informed director, Morena Duran that this report dated 01/18/2022 document(s) 2 of Type A citations. Type A citations which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Anomeh Eivazian informed the director, Morena Duran to provide a copy of this licensing report dated 01/18/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the director, Morena Duran.


REPORT END 2 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20211214152757
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/19/2022
Section Cited
CCR
101538.3(b)
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Indoor Activity Space for School-Age Children. In combination programs, indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children. This requirement was not met as evidenced by ...
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Per director, Per director, two infant teacher assistants who had teacher qualifications on file were promoted to teacher effective 12/27/2021 and one fully qualified teacher was hired on 12/27/21. Per director, effective 12/27/21 Infant and preschool children have not commingle together anymore in the mornings.
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Based on staff interviews on 12/20/2021, infants and toddlers commingle together in the morning from 7:30 a.m. to 8:30 a.m. in infant classrooms. This poses an immediate health and safety risk to the children in care.
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A written declaration will be submitted to LPA by plan of correction due date, 01/19/2022.
Type A
01/19/2022
Section Cited
CCR
101416.5(b)
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Staff-Infant Ratio
There shall be a ratio of one teacher for every four infants in attendance.
This requirement was not met as evidenced by...
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Per director, Per director, two infant teacher assistants who had teacher qualifications on file were promoted to teacher effective 12/27/2021 and one fully qualified teacher was hired on 12/27/21. Per director, effective 12/27/21 Infant and preschoolers children have not commingle together anymore in the mornings or operate out of ratio.
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LPA Eivazian sign in/out sheets from 11/01/21 to 12/20/21 and observed in different days there were about 13 to 25 children (infants and preschoolers) present in the facility between 7:30 a.m. and 8:30 a..m.. with one teacher and two teacher assistant. This poses an immediate health and safety risk to the children in care.
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A written declaration will be submitted to LPA by plan of correction due date, 01/19/2022.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20211214152757
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2022
Section Cited
CCR
101238(a)
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The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement was not met as evidenced by ...
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Per director, Per director, a Plummer came and checked the leak mark on the ceiling in the hallway and there is no current leak . Per director, the ceiling tile will be replaced and a picture will be submitted to LPA Eivazian by plan of correction due date, 02/28/2022.
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Based on the staff interviews and LPA Eivazian observation on 12/20/21, there is a leak in the ceiling tile in the facility entrance hallway which children only transpass to go to their classrooms. (Pictures were taken)
This poses a potential health and safety risk to the 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.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4