197408763-10-11-2021-30-CC-MRUZ-C7ZULB-20211021154027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197408763
Report Date: 10/11/2021
Date Signed: 10/11/2021 09:54:32 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
08/16/2021 and conducted by Evaluator Denise Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210816114335

FACILITY NAME:	WEST HOLLYWOOD CHILDREN'S ACADEMY		FACILITY NUMBER:	197408763
ADMINISTRATOR:	JOULIANA BARANOVA		FACILITY TYPE:	850
ADDRESS:	1030 N. VISTA STREET		TELEPHONE:	(310) 748-1656
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	35	CENSUS:	DATE:	10/11/2021
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Maria Augustin, Teacher, Beatriz Echeverria,Teacher Assistant and Director		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Staff do not maintain proper teacher-child ratios
Staff do not follow children's modified diet

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

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 5

Control Number 30-CC-20210816114335

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: WEST HOLLYWOOD CHILDREN'S ACADEMY	FACILITY NUMBER: 197408763
	VISIT DATE: 10/11/2021

NARRATIVE

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allegations that Staff do not follow children's modified diet and Staff do not maintain proper teacher-child ratios” are substantiated, means that the allegations are valid because the preponderance of the evidences standard has been met. Licensee was cited Type A deficiency, according to California Code of Regulations Title 22 (see LIC 809D report for deficiencies).
On 08/23/2021 LPA Miranda and Laureano, received a copy of LIC 500- Personnel Form dated 08/23/2021 where Director stated Staff#8 is listed as a Teacher, after reviewing Staff's file, LPAs observed that Staff#8 is not a fully qualified teacher and Staff#2 is not a fully qualified teacher assistant. On 8/23/2021 LPAs observed Staff#2 and Staff#8 providing care and supervision in classroom Little Candy. No fully qualify teacher was present in this classroom- Little Candy. This is a repeat violation.

On 08/23/2021 LPAs requested copy of the modify menu to Director. Director was not able to produce a copy of the modified menu during inspection. LPAs observed that Facility had a menu posted on the wall, the food menu was observed to have missing the following information: dates, amount, age group and food that a child in care has allergy. During this visit, Director provided an updated incomplete menu did not have the modified menu included. A copy of title 22 food services was provided to Director via email.

A copy of this report must be copied and given to all parents and to the parents of any child enrolling within the next 12 months.

LPA provided a copy of the form LIC 9224 Acknowledgement of receipt of licensing Report. Exit interview was conducted with Director, /including, but not limited to Provider Rights, Appeal Procedure and copy of civil penalty document.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 30-CC-20210816114335

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: WEST HOLLYWOOD CHILDREN'S ACADEMY	FACILITY NUMBER: 197408763
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/11/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/15/2021 Section Cited CCR 101216.2(e)	1 2 3 4 5 6 7	(1) An aide who is 18 years of age or older, and who meets the requirements of this section and Section 101216, may escort and/or assist children in going to the bathroom, and may supervise	1 2 3 4 5 6 7	The facility will submit a schedule of children’s activities, which will include the number of qualified staff, number of children, and time of activity for each group of
	8 9 10 11 12 13 14	napping children as specified in Section 101230(c)(1), without being under the direct supervision of a teacher. See 9099C. This is a repeat violation.	8 9 10 11 12 13 14	children, staff for indoor and outdoor activity. The Director will submit the documents to the Department by 10//15/2021.
	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: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 30-CC-20210816114335

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: WEST HOLLYWOOD CHILDREN'S ACADEMY	FACILITY NUMBER: 197408763
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/11/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/15/2021 Section Cited CCR 101227.6	1 2 3 4 5 6 7	Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative.	1 2 3 4 5 6 7	Director will provide a copy of the menu and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. LPA provided a copy of Title 22
	8 9 10 11 12 13 14	Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request. This standard was not met based on evidence obtained through the interviews and observations.	8 9 10 11 12 13 14	Food Services previously. Director will email to LPA Miranda or mail to El Segundo Office until 10 10/15/2021.
	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: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5

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
08/16/2021 and conducted by Evaluator Denise Miranda

COMPLAINT CONTROL NUMBER: 30-CC-20210816114335

FACILITY NAME:	WEST HOLLYWOOD CHILDREN'S ACADEMY		FACILITY NUMBER:	197408763
ADMINISTRATOR:	JOULIANA BARANOVA		FACILITY TYPE:	850
ADDRESS:	1030 N. VISTA STREET		TELEPHONE:	(310) 748-1656
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	35	CENSUS:	DATE:	10/11/2021
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Maria Augustin, Teacher, Beatriz Echeverria,Teacher Assistant and Director		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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9

Staff do not provide adequate supervision to children in care

INVESTIGATION FINDINGS:

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On 10/11/2021 8:10AM, Licensing Program Analyst (LPAs) Denise Miranda and Carolyn Tuba, conducted an unannounced visit at West Hollywood Academy, located at 1030 N. Vista Blvd, Los Angeles, CA 90046 for the purpose of delivering the investigation findings the above-mentioned allegation. All adults present are associated to the facility. LPA met with teacher Maria Augustin, Teacher and Beatriz Echeveria, Teacher Aide and discussed the purpose of the visit. Upon arrival LPAs observed 1 child and 2 staff. At 9:06AM LPA Tuba observed 12 children with 5 staff. LPAs observed Director arrived at the facility at 8:57AM and discussed the purpose of the visit. Based on the information gathered throughout the course of the investigation which includes LPAs observations and interviews, the allegation above is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there are not a preponderance of the evidences to prove that the alleged violation occurred.
An exit interview was conducted, and a copy of this report was provided to Jouliana Baranova, Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5