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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197412742
Report Date: 12/04/2019
Date Signed: 12/04/2019 05:43:53 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
09/10/2019 and conducted by Evaluator Jillinda Chandler
COMPLAINT CONTROL NUMBER: 30-CC-20190910162814
FACILITY NAME:CHILDREN OF PROMISE CHILD DEV. CENTERFACILITY NUMBER:
197412742
ADMINISTRATOR:KIMBERLY WILLIAMSFACILITY TYPE:
830
ADDRESS:3130 WEST 111TH PLACETELEPHONE:
(310) 677-3045
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY:16CENSUS: 6DATE:
12/04/2019
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:AdminstratorTIME COMPLETED:
05:56 PM
ALLEGATION(S):
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1. Staff failed to follow child’s care plan.

2. Staff failed to inform parents of child's condition.

3. Staff failed to properly clean baby bottles.
INVESTIGATION FINDINGS:
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On 12/4/2019 Licensing Program Analyst (LPA) made an unannounced visit to the above location for the purpose of delivering finding to the above allegations. During to days visit a file review was conducted and staff interviewed.

Based on evidence collected and review of relevant information it was found that the above allegations shall be substantiated; meaning that that the allegation is valid because the preponderance of the evidence standard has been met.

Citations were issued and a copy of this report will be mailed to the center with-in 5 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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-20190910162814
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: CHILDREN OF PROMISE CHILD DEV. CENTER
FACILITY NUMBER: 197412742
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2019
Section Cited
CCR
101427(b)(3)(D)(4)
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(b) There shall be an individual feeding plan for each infant.
(3) The plan shall include the following items:
(D) Schedule for introduction of solid and new foods.
(4) The plan shall be updated as often as the authorized representative wants, or as necessary to
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Staff shall immediately update child #1 service plan dated 5/25/19 to reflect any changes. Staff shall update all service plans as instructed by parent and when development advances. Staff has made changes to the care and provisions for infant feeding. Parents shall bring bottles and formula on a daily basis.
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reflect changes in any of the areas specified above. This standard was not met as evidence by; Child #1 feeding plan states that child was to be given prosobe formula only and there was no updated service plan observed in child file and staff fed infant baby food on the day of the incident (9/3/19)
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Type B
12/04/2019
Section Cited
CCR
101226(a)(b)
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 (a)The licensee shall immediately notify the child's authorized representative if the child becomes ill ...(b)The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary. This standard was not met as evidence; When staff observed swelling and reddness of
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Staff shall immediately notify parents of any medical condition they should cause for medical attention and let the parent make a decision for further care, unless it is apparent that the child is in immediate danger.
Director has already provided updates to staff and held a meeting with new procedures
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child #1 eyes and neck indicating a possible allergic reaction, the parent was not informed immediately and staff did not seek medical attention based on there observations, however an allergic reaction should be treated as an medical condition required of medical attention.
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after LPA's visit on 9/19/2019
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: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20190910162814
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: CHILDREN OF PROMISE CHILD DEV. CENTER
FACILITY NUMBER: 197412742
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2019
Section Cited
CCR
101427(n)(1)(2)(3)
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(n) Bottles and nipples maintained by the infant care center shall be sterilized using any of the following methods after each use:(1)Boiled for a minimum of five minutes and air-dried; or(2)Soaked for a minimum of one minute in a sterilizing solution using ½ cup of bleach and five gallons of water and air-dried; or
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Staff shall ensure that infants bottles are properly cleaned or rinsed prior to returning them to the parent at the end of the day. By using the proper method of cleaning. Bottles are now rinsed and sent home with parent at the end of the day.
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(3) Bottles may be washed and sterilized using a dishwasher. This standard was not met as evidence by: Prior to the incident bottles were maintained by the center, based on the above and statement from staff responsible for cleaning the bottles,proper procedures were not followed resulting in mold in child #1s bottle
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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: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3