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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191606802
Report Date: 05/20/2024
Date Signed: 05/20/2024 04:34:40 PM

Substantiated


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
04/24/2024 and conducted by Evaluator Veronica Wheatley
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20240424091154
FACILITY NAME:CHILD LANEFACILITY NUMBER:
191606802
ADMINISTRATOR:ROBERTA RAMIREZFACILITY TYPE:
850
ADDRESS:769 W. 3RD STREETTELEPHONE:
(310) 514-4999
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:62CENSUS: 44DATE:
05/20/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Aolelani LutuTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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5/20/24, Licensing Program Analyst (LPA) V. Wheatley conducted an unannounced inspection and met with Site Supervisor Aolelani Lutu regarding the above allegation.

On 4/30/24, LPA toured the facility, obtained a copy of facility roster, personnel report, and conducted staff interviews. On 5/14/24, LPA interviewed additional witnesses regarding the allegation.

Based on the LPA's observation, information obtained and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Staff member #1 has been violating children's personal rights.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
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 2
Control Number 30-CC-20240424091154
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: CHILD LANE
FACILITY NUMBER: 191606802
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/21/2024
Section Cited
CCR
101223(a)(3)
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101223(a)(3) Personal Rights - The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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The Site Supervisor will ensure that all children are safe, treated appropriately and without any improper treatment by staff members. Site Supervisor will submit a Plan of Correction to the Department regarding additional professional development training Challenging Behavior training will be conducted on June 13, 2024.
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This is evidenced by:
Based on interviews which were conducted, Staff #1 has been violating children's personal rights by intimidation, patting children's back too hard, grabbing a child's arm inappropriately.
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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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2024
LIC9099 (FAS) - (06/04)
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