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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191670880
Report Date: 12/11/2020
Date Signed: 12/14/2020 01:27:43 PM



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
03/03/2020 and conducted by Evaluator Susann Sanchez
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200303163919
FACILITY NAME:CSUDH CHILDRENS CENTERFACILITY NUMBER:
191670880
ADMINISTRATOR:MICHELLE JOHNSONFACILITY TYPE:
850
ADDRESS:1000 E VICTORIATELEPHONE:
(310) 243-1015
CITY:CARSONSTATE: CAZIP CODE:
90747
CAPACITY:50CENSUS: 0DATE:
12/11/2020
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Rasheedah Shakoor, Exective DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Personal Rights- Facility staff handled a child roughly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Susann Sanchez conducted an announced complaint inspection to the above facility via Zoom due to the COVID19 Pandemic. The facility above is currently closed to the COVID19 Pandemic. LPA met with Rasheedah Shakoor, Exective Director and went over the findings by telephone.

During the investigation LPA interviewed staff, parents, and children. LPA obtained a copy of the facility roster and copies of other supporting documentation.

After interviewing staff #1 and reviewing supporting documentation were staff #1 submitted a written statement and staff #1 admitadmitted the she/he held child #1 arm and that child #1 began to cry. The above allegation is found to be Substantiated. A finding of Substantiated means that the allegation has been found to be valid because the preponderance of the evidence standard has been met.
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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2020
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 54-CC-20200303163919
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: CSUDH CHILDRENS CENTER
FACILITY NUMBER: 191670880
VISIT DATE: 12/11/2020
NARRATIVE
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Based on information obtained during this investigation, the following Type B deficiency listed on the attached LIC 809d are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Rasheedah Shakoor, Executive Director by telephone due to Center being closed because of the COVID19 pandemic. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Licensee signature.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20200303163919
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: CSUDH CHILDRENS CENTER
FACILITY NUMBER: 191670880
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2020
Section Cited
CCR
101223(a)(3)
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Personal Rights
The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Per the director staff #1 was put on administrative leave as soon as the facility was aware of the incident. Staff #1 has not returned to the facility since they closed on 03/13/2020 due to the COVID19 pandemic
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 staff #1 admittingshe/he held child 1 by the arm. This poses a potential 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3