197494017-10-14-2022-54-CC-VCOK-CKMTMU-20221028145142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494017
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:31:18 PM

Substantiated

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
07/29/2022 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220729092527

FACILITY NAME:	MARTIN LUTHER KING JR LEARNING CENTER - INFANT		FACILITY NUMBER:	197494017
ADMINISTRATOR:	CAMARENA,E & LUNA,R		FACILITY TYPE:	830
ADDRESS:	12029 S WILMINGTON AVE		TELEPHONE:	(424) 338-1980
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	39	CENSUS: 28	DATE:	10/14/2022
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Ana Martinez, Assistant Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Infant sustained injury while in care

INVESTIGATION FINDINGS:

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Licensing program analyst (LPA) Alicia Mooberry conducted an unannounced complaint inspection for the purpose of delivering findings for the above allegation. LPA met with Assistant Director, Ana Martinez and toured the facility. The following census was taken: Infant room, 3 staff with 11 children. Toddler 1/Room 114, 1 staff with 8 napping children. Toddler 2/Room 116, 1 staff with 9 napping children.

During the investigation LPA conducted interviews with the staff and witnesses. The information and evidence obtained, including photos and physician report confirm that Child #1 was injured when the door of a low cabinet was closed on child’s finger, causing a partial fingertip separation to the child’s right ring finger.

The Department finds the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

---Report continues on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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-20220729092527

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
	VISIT DATE: 10/14/2022

NARRATIVE

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Witnesses interviewed state that on 7/28/22 Child1 opened an unlocked cabinet door in Toddler room 2/Rm 116. Child1 then attempted to pull themselves up by placing their hand on the top of the cabinet door. Child2 then closed the cabinet door, on Child1’s finger between the door and the metal magnet on inside of door. Child 1 was immediately assisted by the Staff at the facility and taken to the hospital neighboring the facility.
Based on document review and staff interviews there were 8 children in care and 2 staff present during the incident. Staff 1 stated that observed the incident but was unable to reach the child before the cabinet closed. Staff interviewed stated the cabinet is to be closed at all times, it was not clear as to why the door was unlocked.

The facility is being cited one Type A deficiency for failing to protect the personal rights of a child in care, in accordance with Title 22, California Code of Regulations. (See LIC 9099D). A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Assistant Director, Ana Martinez, during which appeal rights were explained. A copy of the appeal rights were provided.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
07/29/2022 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20220729092527

FACILITY NAME:	MARTIN LUTHER KING JR LEARNING CENTER - INFANT		FACILITY NUMBER:	197494017
ADMINISTRATOR:	CAMARENA,E & LUNA,R		FACILITY TYPE:	830
ADDRESS:	12029 S WILMINGTON AVE		TELEPHONE:	(424) 338-1980
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	39	CENSUS: 28	DATE:	10/14/2022
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Ana Martinez, Assistant Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not properly supervising infant

INVESTIGATION FINDINGS:

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Licensing program analyst (LPA) Alicia Mooberry conducted an unannounced complaint visit for the purpose of delivering findings for the above allegation. LPA met with Assistant Director, Ana Martinez and toured the facility. The following census was taken: Infant room, 3 staff with 11 children. Toddler 1/Room 114, 1 staff with 8 napping children. Toddler 2/Room 116, 1 staff with 9 napping children.
During the investigation LPA conducted interviews with staff and witnesses. The information and evidence obtained confirm that Child #1 was injured while in care. Based on document review and staff interviews there were 8 children in care and 2 qualified staff present during the incident. Staff 1 stated they observed the incident but was unable to reach the child before the cabinet closed. Staff 2 did not observe the incident was changing diapers in the classroom.
Although the allegation may have happened or is valid there is not a preponderance of evidence to prove alleged violations did or did not occur, there for the allegation are unsubstantiated.
The notice of site visit was posted where the parent/guardian of children enter and exit the facility.
Exit interview conducted with Assistant Director, Ana Martinez during which appeal rights were explained and copy provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 54-CC-20220729092527

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/17/2022 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Per facility representative, Ana Martinez; the cabinets in all classroom, accessible to children in care are no longer used. The keys have been removed from all of the classroom to avoid unlocking cabinets. Facility representative states a written statement with plan of correction will be sent to the department by POC due date 10/17/22.
	8 9 10 11 12 13 14	The licensee failed to ensure the personal rights of Child #1, as they had access to unlocked cabinet, cabinet door was closed on child's finger causing injury, cut and bleeding. This poses an immediate risk to the health and saferty 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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC9099 (FAS) - (06/04)

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