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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191871609
Report Date: 10/03/2019
Date Signed: 10/03/2019 12:40:59 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
09/30/2019 and conducted by Evaluator Karren Starks
COMPLAINT CONTROL NUMBER: 30-CC-20190930092256
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: 11DATE:
10/03/2019
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Jacqueline SumpterTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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PERSONAL RIGHT-Staff denies child playtime
INVESTIGATION FINDINGS:
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On 10/3/19, LIcensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a complaint investigation. LPA met with Lead Teacher, Jacqueline (Jackie) Sumpter who had 11 children in care with 3 additional teachers present.

Based on interviews conducted and information obtained the allegation that a staff member restricts a child to only play on one apparatus for an extended period of time during outdoor play is deemed substantiated. Meaning that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiency is being cited.

Copy of report, 9099D, Appeal Rights and Notice of Site visit are being 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: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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 2
Control Number 30-CC-20190930092256
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: 10/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2019
Section Cited
CCR
101223(3)
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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:
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The Director will conduct training on Children's Personal Rights, which includes the viewing of the videos available on the Department website: www.ccld.ca.gov regarding Children's Personal Rights. Provide LPA a copy of the agenda and a sign in sheet no later than 10/17/19.
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interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This is evident by a child being restricted to only one outdoor apparatus
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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: 10/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2