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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191871609
Report Date: 05/28/2019
Date Signed: 05/28/2019 11:29:36 AM



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
05/17/2019 and conducted by Evaluator Karren Starks
COMPLAINT CONTROL NUMBER: 30-CC-20190517160738
FACILITY NAME:JIM GILLIAM CHILD CARE CENTERFACILITY NUMBER:
191871609
ADMINISTRATOR:CATHERINE HILLIARDFACILITY TYPE:
850
ADDRESS:4000 SO. LA BREA AVE.TELEPHONE:
(323) 291-5929
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:45CENSUS: 14DATE:
05/28/2019
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jacqueline SumpterTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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PERSONAL RIGHTS - Facility had an outbreak of lice
REPORTING REQUIREMENTS - Facility did not report the lice epidemic.
INVESTIGATION FINDINGS:
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On 05/28/19, Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a complaint investigation. LPA met with Lead Teacher, Jacqueline Sumpter who had 14 children in care. Proper Teacher/Child Ratios were observed. The Director was not present during the inspection, but did contact LPA via telephone during visit.
Based on interviews conducted and information obtained the allegations of Personal Rights and Reporting requirements are deemed substantiated. There was an outbreak of lice within the facility with the parents being notified. The infected children were sent home or kept away from the facility with dailiy checks being conducted by the staff. The faciltiy removed or sanitized the soft toy items which included the stuffed toys, hats and bedding and sanitized the facility. The facility failied to report the epidemic to the Department.
Type A deficiency is being cited for the Personal Rights violation and a Type B citation for not reporting the epidemic to the Department. The facility provide the parents of the children with a copy and post this report for 30 days. As well as providing a copy to anyone who enrolls within the next 12 months.
Copy of report, LIC 9099D, LIC9224, Appeal Rights and Notice of Site Visit issued.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
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-20190517160738
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: JIM GILLIAM CHILD CARE CENTER
FACILITY NUMBER: 191871609
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/28/2019
Section Cited
CCR
101223
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PERSONAL RIGHTS - To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The faclity will provide inservice training to staff on children's Personal Rights, including healthful accomodations and provide LPA with a copy of the sign in sheet no later than 06/04/2019 .
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The requirement is not met as evidenced by there being an epedic of children with head lice within the facility
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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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20190517160738
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: JIM GILLIAM CHILD CARE CENTER
FACILITY NUMBER: 191871609
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2019
Section Cited
CCR
101212d1E
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REPORTING REQUIREMENTS - Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition,
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Director will provide LPA with a Declaration stating that she will adhere to Title 22 regulations for any further incidents that occur at the facilty that require reporting to the Department, and report within 24 hrs. and follow up with a written report using Unusual Incident /injury Report (LIC624), submitted no later than 06/04/2019
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a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

This requirement is not met as evidenced by:
The facility failed to notify the department of the lice epedimic.
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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: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3