197419908-1-16-2020-54-CC-TCON-BLRNX3-20200213095023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419908
Report Date: 01/16/2020
Date Signed: 01/16/2020 12:35:17 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
01/15/2020 and conducted by Evaluator Denise Gibbs

COMPLAINT CONTROL NUMBER: 54-CC-20200115130727

FACILITY NAME:	HALL FAMILY CHILD CARE		FACILITY NUMBER:	197419908
ADMINISTRATOR:	HALL, CUPID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 819-2445
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY:	14	CENSUS: 0	DATE:	01/16/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Cupid Hall, Licensee		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Uncleared adult present in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced complaint inspection on 1/16/2020 at 10:30 AM to investigate the above allegation. LPA toured facility with licensee, Cupid Hall. There were 0 children present during this visit.

During the course of investigation LPA made observations and conducted an interview with licensee. Licensee disclosed that A1 does reside in the home. Licensee and A1 are working on gathering documentation to proceed with his fingerprint clearance. Per licensee, she will make sure A1 is not at the facility while daycare children are present.

Based on the available information, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, 102370(d) Criminal Record Clearance, is being cited on the attached LIC. 9099D. A violation regarding Criminal Record Clearance warrants an immediate civil penalty of 100 per day and is hereby assessed, see LIC 421IM)------------PAGE 1

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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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-20200115130727

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: 01/16/2020

NARRATIVE

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This poses an immediate Health and Safety risk to clients in care.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the Parent Notification Requirements was provided to the licensee, along with a copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.

Exit interview was conducted with Cupid Hall, Licensee, including, but not limited to Appeal Procedures and Agencies Consultative Role. --------------------------PAGE 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 54-CC-20200115130727

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: 01/16/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/17/2020 Section Cited CCR 102370(d)(1)	1 2 3 4 5 6 7	102370(d)(1) 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 This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Per licensee, A1 resides in the home with his children. Licensee agrees to have A1 stay away from the facility while daycare children are present and submit documentation needed for exemption by this weekend.
	8 9 10 11 12 13 14	Based on interview and record review licensee allowed A1 to be in the home while daycare children were present knowing that his fingerprint clearance is pending. This poses an immediate Health, Safety, or Personal Rights risk to children in care.	8 9 10 11 12 13 14	*THIS REPORT IS BEING AMENDED TO ADD MISSING SIGNATURE
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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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC9099 (FAS) - (06/04)

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