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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191602514
Report Date: 01/29/2024
Date Signed: 01/29/2024 04:01:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 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
01/26/2024 and conducted by Evaluator Loyce Phillips
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20240126135634
FACILITY NAME:DER KINDER GARDEN INFANT CENTERFACILITY NUMBER:
191602514
ADMINISTRATOR:JAYASURIYA, TARISHAFACILITY TYPE:
830
ADDRESS:1843 10TH ST.TELEPHONE:
(310) 318-3838
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:30CENSUS: 14DATE:
01/29/2024
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:TARISHA JAYASURIYA, DIRECTORTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Allegation: Personal Rights- Staff did not provide a safe sleeping environment for infants.
INVESTIGATION FINDINGS:
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On 1/29/2024, Licensing Program Analyst (LPA) Loyce Phillips arrived at the facility for the purpose of conducting an initial complaint investigation. Upon arrival LPA met with Director, Tarisha Jayasuriya. LPA advised Director the purpose of the inspection was due to a complaint received by the El Segundo Child Care Regional Office (ESCCRO). LPA observed 6 infants with 3 staff members and 8 toddlers with 2 staff members.

During inspection, LPA toured the facility, obtained pertinent documents, interviewed staff and documented observations. LPA observed 2 infants sleeping with bibs on around their necks. LPA advised staff to remove bibs and correction was made immediately. LPA observed an empty pack n play with a hanging toy device. LPA asked staff to remove the hanging toy device and correction was made. During staff interviews, S1 and S2 acknowledge and stated a blanket was placed in the pack n' play while infant was sleeping.
9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
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 3
Control Number 30-CC-20240126135634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DER KINDER GARDEN INFANT CENTER
FACILITY NUMBER: 191602514
VISIT DATE: 01/29/2024
NARRATIVE
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Therefore, the allegation that staff did not provide a safe sleeping environment for infants are deemed substantiated. A Substantiated finding means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety Codes.

A copy of this report must be provided to the authorized representative of all currently enrolled children and any newly enrolled child for the following 12 months. The acknowledgement of receipt of Licensing Reports (LIC 9224) shall be signed and kept in each of the children’s records.

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 results in a civil penalty of 100.00.

Exit interview conducted, report and appeals rights were discussed and provided to Director.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20240126135634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DER KINDER GARDEN INFANT CENTER
FACILITY NUMBER: 191602514
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2024
Section Cited
CCR
101439.1(f)(3)
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101439.1(F)Cribs shall be free from all loose articles and objects, including blankets and pillows.(3)There shall be no objects hanging above or attached to the side of the crib. This requirement was not met as evidence based on LPA's observation of infant safe sleep environment. LPA observed
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Director agreed to review PIN 20-24-CCP Safe Sleep Regulations to ensure the facility is in compliance. Director will provide copies of PIN 20-24-CCP to staff to review and will provide copies with staff signatures to LPA by 1/30/2024.
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2 infants sleeping with bibs on and a hanging toy device over an empty pack n play. In addition S1 and S2 acknowledge and stated that a blanket was placed in a pack n' play while infant was sleep which poses an immediate health, safety, risk to 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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
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