197493784-7-20-2023-58-CC-RRAS-CV9NY5-20230901105207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197493784
Report Date: 07/20/2023
Date Signed: 07/20/2023 12:44:04 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
07/12/2023 and conducted by Evaluator Maria Rendon

COMPLAINT CONTROL NUMBER: 58-CC-20230712085540

FACILITY NAME:	KID'S CLUB PROGRAMS		FACILITY NUMBER:	197493784
ADMINISTRATOR:	ROBERTS, TONY		FACILITY TYPE:	840
ADDRESS:	23838 KITTRIDGE STREET		TELEPHONE:	(818) 591-2582
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	52	CENSUS: 20	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Anthony Robert		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Neglect/Lack of Supervison-Staff did not supervise child appropriately

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPM) Lisa Rios and Licensing Program Analyst (LPA) Maria Rendon conducted an unannounced complaint inspection on 7/20/23 to investigate the above allegation. LPM and LPA arrived at the facility at 9:43 AM and met with director Anthony Roberts who guided on a tour of the facility. There were 20 children and 4 staff (2 of which are volunteers) upon arrival.
As LPM and LPA toured the facility, S#1 stated, S#2 took C#1 and C#2 to the restroom and waited outside. While waiting outside, the bathroom lacked the requirement of visual observation at all times. This resulted in a Type A citation for lack of visual supervision and therefore the above allegation was substantiated.
Upon receipt of this report, the Licensee shall post the Notice of Site visit 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.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Maria Rendon	TELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
07/12/2023 and conducted by Evaluator Maria Rendon

COMPLAINT CONTROL NUMBER: 58-CC-20230712085540

FACILITY NAME:	KID'S CLUB PROGRAMS		FACILITY NUMBER:	197493784
ADMINISTRATOR:	ROBERTS, TONY		FACILITY TYPE:	840
ADDRESS:	23838 KITTRIDGE STREET		TELEPHONE:	(818) 591-2582
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	52	CENSUS: 20	DATE:	07/20/2023
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Anthony Robert		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Qualifications-Staff do not have appropriate training

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPM) Lisa Rios and Licensing Program Analyst (LPA) Maria Rendon conducted an unannounced complaint inspection on 7/20/23 to investigate the above allegation. LPM and LPA arrived at the facility at 9:43 AM and met with director Anthony Roberts who guided on tour of the facility. There were 20 children and 4 staff (2 of which are volunteers) upon arrival.

As LPM and LPA toured the facility, S#1 stated, 2 staff members are volunteers and under 18 years of age. LPM Rios and LPA Rendon substantiated the above allegation based on statements made by S#1 and this resulted in a Type B citation.

An exit interview was conducted and above allegation was discussed. A copy of this report and Notice of Site Visit, which needs to be posted for 30 days, was provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Maria Rendon	TELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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 58-CC-20230712085540

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KID'S CLUB PROGRAMS	FACILITY NUMBER: 197493784
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/20/2023 Section Cited CCR 101216(d)(2)	1 2 3 4 5 6 7	101216 Personnel Requirements (d)The following child care center personnel shall be at least 18 years old: (2) Persons, including volunteers, who provide any element of care and supervision to children. This requirement is not met as evidence by...based on statements made by S#1, two staff members	1 2 3 4 5 6 7	LPM and LPA provided regulations for volunteers. Director agrees that all volunteers will be 18 years of age.
	8 9 10 11 12 13 14	who are volunteers are not 18 years of age.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Maria Rendon	TELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 58-CC-20230712085540

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KID'S CLUB PROGRAMS	FACILITY NUMBER: 197493784
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/20/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child shall be left without the supervision of a teacher at any time.... Supervision shall include visual observation.	1 2 3 4 5 6 7	Director agrees to have a staff meeting regarding visual supervision of children at all times including when at the restroom. An attendance record of meeting will be emailed to maria.rendon@dss.ca.gov within 30 days.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: based on statements made by S#1, S#2 did not have visual supervision while children were using the bathroom.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Maria Rendon	TELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 58-CC-20230712085540

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KID'S CLUB PROGRAMS	FACILITY NUMBER: 197493784
	VISIT DATE: 07/20/2023

NARRATIVE

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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.

An exit interview was conducted with the above allegation and it was discussed with director Anthony Roberts. A copy of this report was provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Maria Rendon	TELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC9099 (FAS) - (06/04)

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