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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191593822
Report Date: 10/10/2019
Date Signed: 10/10/2019 12:43:55 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
06/28/2019 and conducted by Evaluator Warren Birks
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20190628100324
FACILITY NAME:CHARTER OAK DAY SCHOOL-INFANT CENTERFACILITY NUMBER:
191593822
ADMINISTRATOR:BARRAZA, SARAHFACILITY TYPE:
830
ADDRESS:20350 E. CIENEGA AVE.TELEPHONE:
(626) 967-6611
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:15CENSUS: 6DATE:
10/10/2019
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Viviann IvoryTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Facility failed to meet child's needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced complaint inspection to investigate the above allegation. LPA met with Director Viviann Ivory who nprovided information for the visit.

LPA reviewed an Ouchie Report, an Incident Report and a Caregiver Report to Parent. LPA also interviewed staff. Note: Adult #1 was currently unavailable. There were no disclosures from staff that they witnessed or were involved with the allegation. LPA observed the Ouchie Report, Incident Log and caregiver's report describe an incident that determine no violations at this time. The incident log also indicated a similiar incident happened outside of the childcare facility. Note: The reports are dated but have no parent signature line (which acts as a parent/guardian receipt).

At this time, based on interviews and documentation the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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 33-CC-20190628100324
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: CHARTER OAK DAY SCHOOL-INFANT CENTER
FACILITY NUMBER: 191593822
VISIT DATE: 10/10/2019
NARRATIVE
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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. Exit interview conducted with Director Viviann Ivory.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2