191601954-10-21-2019-30-CC-SJSN-BHCU9F-20191027152305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191601954
Report Date: 10/21/2019
Date Signed: 10/21/2019 02:18:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2019 and conducted by Evaluator Sabrina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20190910163046

FACILITY NAME:	UCLA EARLY CARE AND EDUCATION-INFANTS		FACILITY NUMBER:	191601954
ADMINISTRATOR:	AMY AGNEW		FACILITY TYPE:	830
ADDRESS:	101 S. BELLAGIO DR.		TELEPHONE:	(310) 825-5086
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90095
CAPACITY:	60	CENSUS: 36	DATE:	10/21/2019
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Amy Agnew, Center Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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9

Staff left day care children unattended.

INVESTIGATION FINDINGS:

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13

On 10/21/2019, Licensing Program Analyst (LPA) Sabrina Martinez arrived at UCLA Early Care and Education-Infants for the purpose of delivering the investigation findings on the above mentioned allegation. LPA met with Amy Agnew, Center Director, and discussed the purpose of the visit.

Based on interviews conducted and other information gathered through the course of the investigation, it was revealed that on 09/10/2019 at approximately 08:50 am, facility staff walked in and out of the nap room and failed to visually observe a sleeping infant in the nap room. The parent who observed the napping infant immediately notified staff members that a child was without adult supervision. Facility staff was immediately repositioned in the nap room. Therefore, the complaint allegation that staff left day care child unattended was substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The facility is issued a Type B citation today, 10/21/2019. (See LIC 9099-D for deficiency cited). An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit were provided to Amy Agnew, Center Director.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

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 30-CC-20190910163046

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: UCLA EARLY CARE AND EDUCATION-INFANTS	FACILITY NUMBER: 191601954
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/21/2019 Section Cited CCR 101429(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision for Infants. Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended. This requirement it not met as evidenced by: Based on interviews conducted, it was revealed that on 09/10/19	1 2 3 4 5 6 7	Director sent out a memo to facility staff stating that there should always be one teacher supervising children in the nap room. LPA obtained a copy of the memo during today's visit. The deficiency is cleared today and a copy of the citations clearance letter will be provided today,10/21/2019.
	8 9 10 11 12 13 14	at approx.08:50 am,staff walked in & out of the nap room & failed to visually observe a sleeping infant. The parent who observed the infant immediately notified staff members that a child was w/o adult supervision. Staff was immediately repositioned in the nap room. This is a Type B citation & poses a potential health & safety risk to children in care.	8 9 10 11 12 13 14
	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: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

LIC9099 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2019 and conducted by Evaluator Sabrina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20190910163046

FACILITY NAME:	UCLA EARLY CARE AND EDUCATION-INFANTS		FACILITY NUMBER:	191601954
ADMINISTRATOR:	AMY AGNEW		FACILITY TYPE:	830
ADDRESS:	101 S. BELLAGIO DR.		TELEPHONE:	(310) 825-5086
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90095
CAPACITY:	60	CENSUS: 36	DATE:	10/21/2019
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Amy Agnew, Center Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff using inappropriate napping methods

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3