197419908-9-4-2019-54-CC-TCON-BHW5KM-20191113190143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419908
Report Date: 09/04/2019
Date Signed: 09/04/2019 01:16:54 PM

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
08/30/2019 and conducted by Evaluator Denise Gibbs

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20190830130505

FACILITY NAME:	HALL FAMILY CHILD CARE		FACILITY NUMBER:	197419908
ADMINISTRATOR:	HALL, CUPID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 816-4752
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY:	14	CENSUS: 2	DATE:	09/04/2019
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cupid Hall, Licensee		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Uncleared adults providing care to children

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced inspection to conclude the investigation for the above allegation. LPA toured facility with licensee, Cupid Hall. There were 2 children present during this visit, with licensee, one assistant (staff #2), and 2 adults (adult #1 and adult #2)

Apon arrival LPA was met at the door by adult #1 who informed that the licensee was dropping off children and would be back shortly. LPA observed adult# 1 caring for daycare child #1 and her own child (child #2). Adult #1 informed that she has been living in the home for a few months. LPA also obsrved adult #2 in the home. Neither adult #1 or #2 have finger print clearance. LPA was met by Licensee about 10 minutes later. Per licensee, adult # 2 has been living in the home for 3 months. Disclosure was also made by licensee that adult #3, who is also not finger print cleared was present in the home on 8/23/19

Based on LPAs observations and interviews which were conducted, the preponderance of evidence
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20190830130505

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: HALL FAMILY CHILD CARE	FACILITY NUMBER: 197419908
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/05/2019 Section Cited CCR 102370(d)	1 2 3 4 5 6 7	Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility	1 2 3 4 5 6 7	Per licensee, licensee sent adult#1 and adult #2 to get live scanned during inspection. Licensee will have adult #3 get finger print cleared before he comed back to the facility. Licensee will email a copy of the live scan receipt to LPA by POC date 9/5/19
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPA observing uncleared adult #1 in the home providing care to children, uncleared adult #2 in the home and a disclosure by licensee that uncleared adult#3 was in the home interactiong with daycare children on 8/23/19. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14
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	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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 54-CC-20190830130505

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: HALL FAMILY CHILD CARE	FACILITY NUMBER: 197419908
	VISIT DATE: 09/04/2019

NARRATIVE

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standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 102370(d) Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility, are being cited on the attached deficiencies page. This poses an immediate Health and Safety risk to clients in care.

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 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Cupid Hall, licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 4