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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500276
Report Date: 05/02/2019
Date Signed: 05/02/2019 11:32:22 AM



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 CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/16/2019 and conducted by Evaluator Timothy Fields
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20190416133747
FACILITY NAME:GOLDEN WEST PRESCHOOLFACILITY NUMBER:
191500276
ADMINISTRATOR:SANDRINE BELLAIRSFACILITY TYPE:
850
ADDRESS:10248 ALONDRA BLVD.TELEPHONE:
(562) 866-5616
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:80CENSUS: 79DATE:
05/02/2019
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Sandrine BellairsTIME COMPLETED:
11:46 AM
ALLEGATION(S):
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Staff inappropriately handled day-care child while in care
INVESTIGATION FINDINGS:
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A Complaint investigation was conducted by Licensing Program Analyst, Timothy Fields for the purpose of investigating the above allegation. During the course of the investigation LPA obtained pertinent information through interviews and also obtained video footage of the incident in question. Footage shows a child being inappropriately handled by a staff member during breakfast time. Child was physically removed from the eating area prior to the child finishing their breakfast in an inappropriate manner.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101223(a)(1) and 101223(a)(3) Personal Rights, being cited on the attached LIC 9099D.

Exit interview conducted with Director, Sandrine Bellairs. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
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 2
Control Number 54-CC-20190416133747
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN WEST PRESCHOOL
FACILITY NUMBER: 191500276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2019
Section Cited
CCR
101223(a)(1)
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Personal Rights
To be accorded dignity in his/her personal relationships with staff and other persons.

The requirement is not met as evidenced by
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Director states a meeting will take place with all staff regarding personal rights and staff interacting with children in care by POC date 5/1619. An agenda and sign-in sheet will be submitted as proof.
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Video surveillance showing a child being physically removed from the eating area by a staff member in an inappropriate manner. This poses an immediate risk to the health and safety of children in care.
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Type A
05/16/2019
Section Cited
CCR
101223(a)(3)
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Personal Rights
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or
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Director states a meeting will take place with all staff regarding personal rights and staff interacting with children in care by POC date 5/1619. An agenda and sign-in sheet will be submitted as proof.
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withholding of shelter, clothing, medication or aids to physical functioning.
The requirement is not met as evidenced by Child being physically removed from the eating area without being able to finish their breakfast. This poses an immediate risk to the health and safety of 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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2