191513297-2-1-2021-54-CC-TCON-BXUP2J-20210202095557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191513297
Report Date: 02/01/2021
Date Signed: 02/01/2021 11:25:06 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
09/11/2020 and conducted by Evaluator Tiffanie Tran

COMPLAINT CONTROL NUMBER: 54-CC-20200911114506

FACILITY NAME:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	191513297
ADMINISTRATOR:	MARIE JOHNSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 569-9309
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	14	CENSUS:	DATE:	02/01/2021
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Marie Jonhson, Licensee		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Personal Rights- Child sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

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Due to COVID-19 and precautionary measures, Licensing Program Analyst (LPA) T. Tran delivered this final finding of the above complaint allegation by use of via telephone with Licensee, Marie Johnson on 02/01/2021. The Investigation Bureau (IB) conducted an investigation concluded that on 08/21/20 daycare staff acknowledged they were unaware of the injury along the face of C1's eye observed by DCFS representative, Then, on 08/24/20, staff did not observed C1 got bitten on the cheek by another child in care. Therefore, based on the preponderance of evidence, licensee and staff failed to protect child's personal right due to multiple events of unexplained injuries occurred at the facility was substantiated. A finding means that the complaint is substantiated and the allegation is valid because the preponderance of the evidence standard has been met. Facility were cited type A deficiency. Please see Complaint Investigation Report LIC 9099D for deficiency cited. LPA discussed AB633 and informed the licensee that, upon receipt of a Type A deficiency, the facility shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. An exit interview was conducted with the licensee. This report along with a notice of site visit, a copy of the appeal rights was via emailed to licensee. Via email with a read receipt or confirmation of receipt of email, which will act as the licensee's signature.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

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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Control Number 54-CC-20200911114506

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 191513297
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/01/2021 Section Cited CCR 102423(a)(2)	1 2 3 4 5 6 7	Personal Rights- This requirement is not met as evidenced by based on records review and interviews by IB, licensee failed to provide protect C1 personal rights due to child sustained multiple events of unexplained injuries which poses an immediate Health and Safety risk to children in care.	1 2 3 4 5 6 7	Licensee agrees to view (Race to The Top Models) that are available on the department website at ccld.childrenvideos.org regards to children's Personal Rights then submit a short summary of at least one video to CCLD on or before 02/12/2021 in order to clear this citation. In addition, facility will be place in increase monitoring for the next 12 months.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021

LIC9099 (FAS) - (06/04)

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