<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494347
Report Date: 10/16/2023
Date Signed: 10/16/2023 12:50:18 PM


Document Has Been Signed on 10/16/2023 12:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:BRELLA PLAYA VISTA - INFANTFACILITY NUMBER:
197494347
ADMINISTRATOR:KENNER RAKOZFACILITY TYPE:
830
ADDRESS:12746 W. JEFFERSON BL. #3-3100TELEPHONE:
(424) 425-7500
CITY:LOS ANGELESSTATE: CAZIP CODE:
90094
CAPACITY:32CENSUS: 27DATE:
10/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Kim Kern Director & Darien Williams Co-FounderTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/16/2023, Licensing Program Analyst (LPA) Adrian Risher conducted an unannounced case management visit. LPA Risher met with Kim Kern Director and Darien Williams Co-founder. LPA informed director about the purpose of the visit and was granted entry into the facility. LPA observed 27 infants with 8 staff.

The purpose of today's visit is to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 7/21/23. Information was received that staff handled children in a rough manner and yelled at a child.

On 08/03/2023, LPA Adkins conducted interviews with staff and received the following documents: children’s roster, personnel roster, personnel records, staff training roster, parent incident notification, suspected child abuse report and witness statements.

Based on interviews and evidence provided, staff were observed handling children in a rough manner. The preponderance of evidence to prove there was a Personal Rights violation has been met. Staff did not ensure that children's personal rights were secured by refraining from handling children in a rough manner. The facility will be cited on the attached LIC809d. LPA Risher informed Director Kim Kern and Co-founder Darien Williams that this report dated 10/16/2023 documents 1 Type A citation(s) which shall be posted for 30 consecutive days as there was an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Risher informed the Director to provide a copy of this licensing report dated 10/16/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and a copy of the report was provided. Appeal rights were reviewed and


provided.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 10/16/2023 12:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: BRELLA PLAYA VISTA - INFANT
FACILITY NUMBER: 197494347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2023
Section Cited
CCR
101223(a)(3)

1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse... or other actions of a punitive nature...
1
2
3
4
5
6
7
The teacher involved in the incident was terminated as of July 25, 2023. Staff attended a training on Personal Rights that was completed by August 4, 2023.
8
9
10
11
12
13
14
This requirement was not met as evidenced by:Staff did not ensure that children's personal rights were secured by refraining from handling children in a rough manner which poses an immediate risk to the health and safety of the 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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Adrian RisherTELEPHONE: (424) 301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2