197493963-6-20-2019-30-CC-MRUZ-BE4S67-20190715133529

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197493963
Report Date: 06/20/2019
Date Signed: 06/20/2019 12:29:25 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
06/03/2019 and conducted by Evaluator Shandra Powell

COMPLAINT CONTROL NUMBER: 30-CC-20190603090727

FACILITY NAME:	KIDSVERSITY		FACILITY NUMBER:	197493963
ADMINISTRATOR:	INDZHYAN,A.&KHACHATRYAN,M.		FACILITY TYPE:	850
ADDRESS:	310 E ALAMEDA AVE		TELEPHONE:	(818) 476-2639
CITY:	BURBANK	STATE: CA	ZIP CODE:	91502
CAPACITY:	44	CENSUS: 25	DATE:	06/20/2019
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Arshaluys Indzhyan, Director		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Facility staff left daycare child outside unsupervised.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced complaint inspection to investigate the above allegation. LPA met with Arshaluys Indzhyan, Director, who guided LPA on tour of the facility. There were 25 children and 4 staff present upon arrival.

During the investigation LPA conducted staff interviews, interviewed reporting party and reviewed video footage.

Information provided by the complainant indicated that Child #1 was standing outside the facilitys front door between the front door and facility gate alone. The facility gate was left open by staff. Staff #1 and Staff #2 were observed to be standing outside on the sidewalk infront of the house next to facility. Complainant arrived and took Child #1 back into the school. Staff #3 entered the school office and met the Complainant and Child #1 a couple of minutes after they had entered the open door to the office.

Continued on Pg.2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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 30-CC-20190603090727

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: KIDSVERSITY	FACILITY NUMBER: 197493963
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/08/2019 Section Cited CCR 101229	1 2 3 4 5 6 7	The licensee shall provide care and supervision as necessary to meet the children's needs.No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.	1 2 3 4 5 6 7	Director added child proof gate between hallway and office. Director will hire additional teachers/aides. Signs on front door of office read "Please make sure to close the door" per Director the sign will be posted at all times. Director will email LPA an undated LIC 700 showing additional staff hired.
	8 9 10 11 12 13 14	The requirement was not met by evidence of interviews and video footage. This poses an immediate risk to the health and safety of children in care.	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: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 30-CC-20190603090727

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: KIDSVERSITY	FACILITY NUMBER: 197493963
	VISIT DATE: 06/20/2019

NARRATIVE

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During interviews conducted staff stated that Child #1 was being watched. Staff stated they were in the office and knew Child #1 was outside alone.

Based on the LPAs observations, interviews concluded and video footage review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 101229 Responsibility for Providing Care and Supervision.

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). 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) Form during this visit.

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 conducted with the Director, during which appeal rights were given and explained. A copy of the Appeal Rights (LIC 9058 01/16) was provided. The Licensee’s signature on this report acknowledges receipt of rights.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC9099 (FAS) - (06/04)

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