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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191670678
Report Date: 06/18/2019
Date Signed: 06/18/2019 02:25:03 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
04/22/2019 and conducted by Evaluator Denise Miranda
COMPLAINT CONTROL NUMBER: 30-CC-20190422130244
FACILITY NAME:CULVER CITY CHILDREN'S CENTERFACILITY NUMBER:
191670678
ADMINISTRATOR:AUDREY STEPHENSFACILITY TYPE:
850
ADDRESS:10800 FARRAGUTTELEPHONE:
(310) 842-4230
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:56CENSUS: 42DATE:
06/18/2019
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Vanessa San Martin, Assistan DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff failed to provide adequate supervision resulting in day care child being touched inappropriately by another child.
Staff failed to provide adequate supervision resulting in day are child being injured by another child.
Facility operating out of ratio.
INVESTIGATION FINDINGS:
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On 06/18/2019 at 11:15am, Licensing Program Analyst (LPA) Denise Miranda arrived at Culver City Children’s Center for the purpose of delivering the investigation findings on the above-mentioned allegations. LPA met with Vanessa San Martin, Assistant Director and discussed the purpose of the visit. LPA toured the facility with Assistant Director at 11:25 am and observed 42 children in care. There were 8 teachers present at the time of the visit. Based on the complaint investigation; the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANIATED. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D. Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit, provide copies of the licensing report to parents/guardians of children in care at the facility and obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file by the close of business the following day or the next day child returns to the facility. The Director must provide the copies of this report to the parents/guardians of new children enrolled up to one year from this date. An exit interview was conducted, appeal rights discussed and printed. Copy of this report was given to assistant director Vanessa San Martin.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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 3
Control Number 30-CC-20190422130244
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: CULVER CITY CHILDREN'S CENTER
FACILITY NUMBER: 191670678
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2019
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement is not met as evidenced by: During the interviews with current parties it was revealed that on 1/17/2019 Teacher#1 was left alone with 12 children
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On 6/18/2019 The facility provided training regarding care and supervision on 4/11/2019 . Director Assistant provided copy the training staff sign-in and agenda. Center Director provided a written statement on how the facility will comply with this requirement.
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while the another teacher#2 step out to the kitchen area. Teacher#1 did not have full visual observation of the location of the two children (Child#1&#2), while one child touched another inappropriate. This is an immediate health and safety risk to children in care.
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Type A
06/19/2019
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement is not met as evidenced by: During the interviews with current parties it was revealed it was common children’s from classroom#2 were allowed to turn off/
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Director Assistant will provide training to her staff regarding incidents procedure and will provide a copy of the agenda and signed by teachers no later than 6/19/2019
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on the light switch. On 1/17/19 Child#1 sustained an injury when trying to turn the light on and child#2 held child’s#1 jacket making her loose balance and hit her mouth on shelve in front of light switch. child#1 tooth got stuck inside of her gums. Facility failed to make arrangements by providing medical assistance.This is an immediate health and 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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20190422130244
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: CULVER CITY CHILDREN'S CENTER
FACILITY NUMBER: 191670678
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/18/2019
Section Cited
CCR
101216.3
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Teacher Child Ratio: Section 18290 of Title 5 of the California Code of Regulations provides:
(C) Preschool (36 months to enrollment in kindergarten) - 1:8 adult-child ratio, 1:24 teacher-child ratio. This requirement is not met as evidenced by: During the interviews with current
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Director Assistant provided training to all teacher on 4/11/2019 and 4/18/2019 a plan of correction showing how the facility will Avoid the classroom be over ratio.
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parties it was revealed that on 1/17/2019 Teacher#1 was alone with 12 while teacher#3 step out to the kitchen area. This is an immediate health and 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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3