191890481-9-11-2019-30-CC-MRUZ-BFWVMW-20190911163411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191890481
Report Date: 09/05/2019
Date Signed: 09/11/2019 12:06:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2019 and conducted by Evaluator Silva Garibyan

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20190520160604

FACILITY NAME:	PACOIMA EARLY EDUCATION CENTER		FACILITY NUMBER:	191890481
ADMINISTRATOR:	SUSAN HAN		FACILITY TYPE:	850
ADDRESS:	11059 HERRICK ST.		TELEPHONE:	(818) 896-3722
CITY:	PACOIMA	STATE: CA	ZIP CODE:	91331
CAPACITY:	115	CENSUS: 69	DATE:	09/05/2019
		UNANNOUNCED	TIME BEGAN:	07:20 AM
MET WITH:	Susan Han/Center Director		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of Supervision: Child was left unsupervised

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Silva Garibyan, Licensing Program Analyst (LPA) conducted an unannounced complaint investigation inspection to the licensed facility to deliver the findings. Upon arrival, LPA met with Susan Han, Center Director. LPA explained the purpose of the inspection. LPA toured the facility with Susan Han, Principal at 07:45 AM and observed 69 children in care. There were 6 teachers and 11 aides present at the time of the visit.
Based on the investigation which include interview with relevant parties and a review of records, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Mom came to pick up Child #2 and Child #1 went after them to give Child #2's jacket. Child #1 never went out the gate. Child #1 was stopped by the office manager and head teacher.
California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 101229(a)(1) is being cited on the attached LIC 9099D page. Appeal rights were discussed and printed. Copy of this report was provided, LIC9224 and Notice of Site visit issued.
Exit interview was conducted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (310) -33-4826
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: 310-337-3754
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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-20190520160604

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: PACOIMA EARLY EDUCATION CENTER	FACILITY NUMBER: 191890481
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/19/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by: Mom came to pick up Child #2 and Child #1 went after them to give	1 2 3 4 5 6 7	Director has conducted an in-service training on the importance of care and supervision, including but not limited to visual observation. Director provided a copy of the Inter-Office Memorandum. The Conference with the teacher held on May 16, 2019.
	8 9 10 11 12 13 14	Child #2's jacket. Child #1 never went out the gate. Child #1 was stopped by the office manager and head teacher. This is a type B dificiency as poses a potential risk to the health and safety of children in care	8 9 10 11 12 13 14	Center Director agrees to provide a written statement on how the facility will comply with this requirement by 09/19/19 Director will provide an agenda of the topics discussed, and a sign in sheet of all employees who has attended the staff meeting. A copy of the LIC 624 ( sent to LPA Majarian via email) was provided.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mary Ruiz	TELEPHONE: (310) -33-4826
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: 310-337-3754
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 2