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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197411017
Report Date: 08/29/2022
Date Signed: 08/29/2022 09:52:18 AM

Substantiated


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
08/02/2022 and conducted by Evaluator Katrina Chicote
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20220802154356
FACILITY NAME:WILSON FAMILY CHILD CAREFACILITY NUMBER:
197411017
ADMINISTRATOR:WILSON, DARLENEC.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 293-5841
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:12CENSUS: 5DATE:
08/29/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Darlene Wilson, LicenseeTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Personal Rights - Day care child sustained injury while in care
INVESTIGATION FINDINGS:
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This was a complaint inspection conducted by Katrina Chicote, Licensing Program Analyst (LPA) on 08/29/2022 at 9:00 AM for the purpose of delivering findings to the above allegation.

During this inspection, LPA was taken on a guided tour of the facility. There were four children (one infant) and one adult present during the visit with one other infant arriving at a later time, totaling five children (two of which are infants).

During the investigation LPA made observations on multiple inspections, conducted interviews, and obtained records. Information gathered from multiple interviews disclosed that there was an incident that took place where a daycare child pulled a board down causing the child to be injured. Children interviewed observed the incident and notified Licensee at a later time. Licensee confirmed this incident took place. Licensee stated she was unaware child injured themselves until children that observed incident notified her. Licensee stated she notified parent as soon as she was informed.
Report Continues - Page 1 of 2
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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-20220802154356
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: WILSON FAMILY CHILD CARE
FACILITY NUMBER: 197411017
VISIT DATE: 08/29/2022
NARRATIVE
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Based on the available information, the preponderance of evidence standard has been met, therefore the above allegation are found to be substantiated.

The following citations are being cited today on the attached LIC 9099D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Darlene Wilson.

Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20220802154356
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: WILSON FAMILY CHILD CARE
FACILITY NUMBER: 197411017
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2022
Section Cited
CCR
102423(a)(2)
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102423 (a)(2) Personal Rights
Each child... from a family child care home shall have certain rights... These rights include... receive safe, healthful, and comfortable... furnishings, and equipment.
This regulation was not met as evidenced by:
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Licesnee states she will move high chairs and play pens away from shelves when in use. LPA observed Licensee move infant furnishings during inspection correcting citation during visit.
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Based on observations and interviews that confirm an incident took place where a child was injured while in care due to being able to reach for a toy and pulling it down while in a bassinet. This poses a potential health, saety, and personal rights risk to children in care.
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CCR
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3