191501069-11-18-2021-33-CC-CGAN-C9G363-20211206165740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191501069
Report Date: 11/12/2021
Date Signed: 11/18/2021 09:51:05 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 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
10/28/2021 and conducted by Evaluator Nolan Tcheng

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20211028151535

FACILITY NAME:	SAN MARINO COMMUNITY CHURCH		FACILITY NUMBER:	191501069
ADMINISTRATOR:	JIHAN MOUSSAUD		FACILITY TYPE:	850
ADDRESS:	1750 VIRGINIA RD		TELEPHONE:	(626) 282-4186
CITY:	SAN MARINO	STATE: CA	ZIP CODE:	91108
CAPACITY:	75	CENSUS: 42	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jihan Massoud - Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Other

INVESTIGATION FINDINGS:

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AMENDED REPORT: Facility representative’s signature was obtained on this page of report due to Final Printing error removing facility representative's signature on the inspection on 11/12/2021. Spacing on page has been adjusted.
Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced inspection of a complaint investigation for the purpose of delivering findings. Upon arrival at 9:35am, LPA met with Director Jihan Massoud to whom the purpose of the visit was explained. At 9:41am, LPA was given a tour of the facility where there were children present at the time of inspection.
Census was taken. There were 0 Staff and 0 Children in Room 1, 2 Staff and 12 children in Room 2, 2 Staff and 6 Children in Room 3, 3 Staff and 11 Children in Room 4, and 2 Staff and 13 Children in Room 6.
During the course of the investigation, interviews were conducted with nine staff members and eight parents. Documentation in the form of Child Care Roster, Copies of class sign in sheets, Staff meeting agenda, email threads, and a letter from the Church business manager were obtained.
REPORT CONTINUES PAGE 1 of 3

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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 5

Control Number 33-CC-20211028151535

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: SAN MARINO COMMUNITY CHURCH	FACILITY NUMBER: 191501069
	VISIT DATE: 11/12/2021

NARRATIVE

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Information from the complainant discloses that staff have not been made aware of the duties during a disaster/emergency and that emergency backpacks have not been updated.

Licensing staff obtained email threads that disclosed early October discussions with parents regarding disaster drills and the use of fire alarms during the drill.

Director states that the staff meeting they were going to have October was canceled due to visit from Licensing. Director disclosed that there has not been any disaster drills conducted this school year. Director provided staff meeting agenda from meeting conducted 11/04/2021 that notes discussion of disaster drills with staff.

Staff interviews with Staff #1 and #8 corroborate the information that the staff meeting in the beginning of October was cancelled due to the visit from Licensing staff. Staff #4 and #5 state that the last disaster drill was conducted in May during last school year. Interviews with 4 of 9 staff disclose that they have updated their emergency backpacks this school year. Staff #3 states there was postponement of disaster drill due to controversy with the alarm being used.

Children interviews were not conducted due to nature of allegation.

Parent interviews made no disclosures regarding the above allegations.

Based upon the evidence as presented above, this agency has investigated the allegation above and has determined that the allegation is Unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies are being cited for the allegations listed above

Exit interview was conducted with Director Jihan Massoud, at 10:45am, including, but not limited to Provider Rights, Appeal Procedures and Agency’s Consultative Role.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

END OF REPORT PAGE 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5