198001890-5-13-2020-54-CC-TCON-BVFUQD-20201117144656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198001890
Report Date: 05/13/2020
Date Signed: 05/13/2020 12:30:44 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
02/18/2020 and conducted by Evaluator Dayna Chambers

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20200218115927

FACILITY NAME:	CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN		FACILITY NUMBER:	198001890
ADMINISTRATOR:	PERAZA, JEANNE		FACILITY TYPE:	840
ADDRESS:	1925 S. BUDLONG AVE.		TELEPHONE:	(323) 731-0703
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90007
CAPACITY:	50	CENSUS:	DATE:	05/13/2020
		UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Covid 19 Crisis - Unable to Meet in Person		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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License: Facility is Operating beyond scope of the license

INVESTIGATION FINDINGS:

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COVID 19 CRISIS
Licensing Program Analyst (LPA) Dayna Chambers conducted an investigation in regards to the above complaint allegation and to deliver findings. Due to the COVID 19 Crisis, LPA Chambers is unable to visit the facility in person. In addition, the facility has been closed due to the Covid 19 virus and Los Angeles County guidelines and restrictions. The 9099 and findings will be delivered to the Director, Jeanne Peraza via email with request for a read receipt at (jeanne.peraza@carouselschool.com)

During the course of this investigation, LPA obtained sign in and sign out sheets, children’s roster, and interviews with staff and parents, LPA confirmed and verified the age of Adult #1 and the hours the adult was present at the program. The roster sign in/sign out sheet shows that on the month of February 2020, Adult #1 was present on the following days: (02/03/20, 02/05/20, 02/05/20, 02/06/20). Sign in/Sign Out Sheet for week of 02/10/2020 through 02/14/20
Continued

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

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-20200218115927

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: CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN	FACILITY NUMBER: 198001890
	VISIT DATE: 05/13/2020

NARRATIVE

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Sign in/Sign Out Sheet for week of 02/10/2020 through 02/14/20
displayed the following times and dates Adult #1 was present at the facility.

02/10/20 - 2:07pm to 5:00pm signed in by - Staff #1
02/11/20 - 1:50pm to 3:01pm signed in by -Staff #1
02/12/20 - 1:50pm to 4:44pm signed in by -Staff #2
02/13/20 - 2:00pm to 5:00pm signed in by - Staff #1
02/14/20 - 2:52pm to 5:00pm signed in Staff #1 and signed out by Staff #2

Adult #1 was absent after 02/14/2020 and terminated or disenrolled on 02/15/20.

ALLEGATION: License: Facility is operating beyond the scope of the license.
During the course of this investigation, LPA Chambers obtained proof that Adult #1 did attend the program and was present without a valid or current Exception/Waiver during the month of February 2020 and the age exceeds the scope of the license. Therefore, the allegation is SUBSTANTIATED.

During the course of the investigation, interviews with staff, parents, and obtaining documents, LPA Chambers confirmed the student’s age and there was not a current/valid “Exception Waiver” on file during the dates in February 2020 when adult #1 was present and enrolled in the program. LPA Chambers reviewed the facility FAS file online and found that the center had been previously cited for a similar incident.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20200218115927

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: CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN	FACILITY NUMBER: 198001890
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/13/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/15/2020 Section Cited CCR 101161(a)	1 2 3 4 5 6 7	101161(a) Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will revise the parent handbook including center procedures that follow CCDL regulations. Additionally, file/records clean-up, create a current children’s roster LIC9040 available for inspection, re-check all enrolled children’s ages currently attending, request waivers and exceptions when necessary,
	8 9 10 11 12 13 14	Based on LPA Chambers investigation and obtaining February 2020 sign in/sign out sheets, interviews, and other documents. LPA confirmed the age of the Adult and that during the time of the complaint, the Adult was enrolled at the facility without a current or valid exception waiver. This poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	that follows the CCLD Dept. regulations. proof that the plan of correction has been followed. The center is currently closed admitting/enrolling limitations defined for staff. Upon re-opening of the center, the licensee will notify LPA Chambers and from that date of reopening; the center will have 30 days to provide proof of these corrections to the Department.
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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: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

LIC9099 (FAS) - (06/04)

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