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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191670722
Report Date: 05/20/2022
Date Signed: 05/20/2022 11:59:05 AM

Unsubstantiated


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 CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/22/2022 and conducted by Evaluator Rita Ramos
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20220422144357
FACILITY NAME:LBUSD-GRANT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191670722
ADMINISTRATOR:KIMBERLY KELLYFACILITY TYPE:
850
ADDRESS:6405 WALNUT AVETELEPHONE:
(562) 422-4686
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:95CENSUS: 38DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kimberly KellyTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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9
Staff hit daycare child
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) RIta Ramos conducted an unannounced complaint inspection on 05/20/22 to investigate the above allegation. LPA arrived at approximately 8:50AM and met with Kimberly Kelly, Coordinating Teacher, who provided LPA with a tour of the faciity. There were 38 children with 10 staff present upon arrival.

During the investigation LPA obtained a copy of the facility roster, conducted interviews, obtained copies of supporting documentation and pictures.

Information provided by the reporting party indicates that Staff #1 hit Child #1 while in care.

Coordinating Teacher states that no children in care have had their personal rights violated.

----- -page 1 of 2

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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 54-CC-20220422144357
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LBUSD-GRANT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191670722
VISIT DATE: 05/20/2022
NARRATIVE
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Staff #1 denies that the incident occurred. All other staff interviewed made no disclosures about the above allegation occurring. Staff #4 was present when the alleged violation occurred and states that all staff are mandated reporters and if the incident would have occurred they would have reported it.

Child #1 states that they were hit by Staff #1.

All other children interviewed made no disclosures pertaining to the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

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. Exit interview was conducted with Kimberly Kelly, Coordinating Teacher, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

----Page 2 of 2

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2