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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197414041
Report Date: 06/27/2022
Date Signed: 06/28/2022 08:34:24 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, 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
04/11/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220411123856
FACILITY NAME:CCRC HEAD START - ARTHUR D. AVILAFACILITY NUMBER:
197414041
ADMINISTRATOR:ARMINE BAGUMYANFACILITY TYPE:
850
ADDRESS:7304 JORDAN AVENUETELEPHONE:
(818) 715-9640
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY:52CENSUS: 0DATE:
06/27/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Krisha EsquivelTIME COMPLETED:
12:31 PM
ALLEGATION(S):
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Personal Rights: Staff forced day care child to clean the bathroom toilet and floor
INVESTIGATION FINDINGS:
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On 6/27/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced complaint visit for the purpose of delivering the findings of the investigation regarding the allegation above. Upon arrival, LPA observed the location is closed. LPA spoke with Early Learning Manager, Krisha Esquivel, over the phone who confirmed location is closed and stated Site Supervisor, Sandra Suarez, is not currently working.

On 4/19/2022, LPA Casillas initiated the complaint investigation and met with Site Supervisor. LPA interviewed Site Supervisor and obtained copies of the following documents: Action Plan for Child 1, P.R.I.D.E handout, personnel report (LIC500), and children’s roster (LIC9040).

Based on interviews with relevant parties, there is a preponderance of evidence to prove the alleged violation did occur. Per Director admission, while Staff 1 did not “force” Child 1 to clean the bathroom toilet and floor,

[CONTINUE PAGE 2]
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
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 30-CC-20220411123856
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: CCRC HEAD START - ARTHUR D. AVILA
FACILITY NUMBER: 197414041
VISIT DATE: 06/27/2022
NARRATIVE
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PAGE 2

Staff 1 was involved in the supervision of Child 1 during the incident where Child 1’s shadow gave the directive to the child to do the cleaning and thereby violated CCRC Head Start’s policy for care and supervision of children. Therefore, the allegation is SUBSTANTIATED. A Type A deficiency was cited during today's inspection (see LIC 9099-D for details).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit (LIC 9213) and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

An exit interview was conducted. A copy of this report was provided to Early Learning Manager, Krisha Esquivel,, via email along with Appeal Rights and Notice of Site Visit. Early Learning Manager, Krisha Esquivel, replied to the email, stating the report was received and read in lieu of a signature.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20220411123856
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: CCRC HEAD START - ARTHUR D. AVILA
FACILITY NUMBER: 197414041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2022
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. (3) To be free from…unusual punishment…humiliation…
This requirement is not evidenced by:
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Early Learning Manager (ELM) agreed to provide a written statement regarding CCRC's approach to working with outside behavior intervention agencies, in particular one-on-one meetings to address expectations and CCRC's policies. ELM agreed to send LPA the written statement via mail and email by 7/8/2022
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Based on interviews, Staff 1 did not ensure that Child 1’s personal rights were protected, when Child 1 was instructed to clean bathroom toilet and floor, which poses an immediate health, safety, or personal rights risk to children in care.
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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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3