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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198005392
Report Date: 04/17/2020
Date Signed: 04/17/2020 11:04:26 AM



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
01/23/2020 and conducted by Evaluator Raul Navarro
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200123165745
FACILITY NAME:ST. TIMOTHY LUTHERAN INFANT CENTERFACILITY NUMBER:
198005392
ADMINISTRATOR:VELIA GUERRAFACILITY TYPE:
830
ADDRESS:4645 WOODRUFF AVENUETELEPHONE:
(562) 421-8441
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:24CENSUS: 0DATE:
04/17/2020
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Karen TaylorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Daycare child is not receiving adequate feedings.
Breast milk is not provided to infant in a safe manner.
Staff dress the daycare child in someone elses clothes.
INVESTIGATION FINDINGS:
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This complaint inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro. Due to COVID-19 and precautionary measures, this inspection was conducted via teleconference to deliver the findings to the complaint investigation. The teleconference was conducted with Administrator Karen Taylor. There were no children present during inspection. Facility is closed as a precautionary measure due to COVID-19.

During the course of the investigation, LPA Navarro conducted interviews with the Complainant, facility staff, and parents. Children were not interviewed due to children being non-verbval. There were no corroborating statements made during the interviews by the staff and parents. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

*Report continues*
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 54-CC-20200123165745
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: ST. TIMOTHY LUTHERAN INFANT CENTER
FACILITY NUMBER: 198005392
VISIT DATE: 04/17/2020
NARRATIVE
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Exit interview was conducted with Karen Taylor, via teleconference, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt to confirm receipt of the report and appeal rights.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
01/23/2020 and conducted by Evaluator Raul Navarro
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200123165745

FACILITY NAME:ST. TIMOTHY LUTHERAN INFANT CENTERFACILITY NUMBER:
198005392
ADMINISTRATOR:VELIA GUERRAFACILITY TYPE:
830
ADDRESS:4645 WOODRUFF AVENUETELEPHONE:
(562) 421-8441
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:24CENSUS: 0DATE:
04/17/2020
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Karen TaylorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not ensure the child goes home with the right bottle.
INVESTIGATION FINDINGS:
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This complaint inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro. Due to COVID-19 and precautionary measures, this inspection was conducted via teleconference to deliver the findings to the complaint investigation. The teleconference was conducted with Administrator Karen Taylor. There were no children present during inspection. Facility is closed as a precautionary measure due to COVID-19.

During the course of the investigation, LPA Navarro conducted interviews with the Complainant, facility staff, and parents. Children were not interviewed due to children being non-verbal. Based on the LPA's interviews and documents obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations (Title 22, Division 12& Chapter Number 1), are being cited on the attached LIC. 9099D.

*Report continues*
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
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 6
Control Number 54-CC-20200123165745
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: ST. TIMOTHY LUTHERAN INFANT CENTER
FACILITY NUMBER: 198005392
VISIT DATE: 04/17/2020
NARRATIVE
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Exit interview was conducted with Karen Taylor, via teleconference, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Licensee via email with a read receipt to confirm receipt of the report and appeal rights.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 54-CC-20200123165745
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: ST. TIMOTHY LUTHERAN INFANT CENTER
FACILITY NUMBER: 198005392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/17/2020
Section Cited
CCR
101416.5(b)
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101416.5-Staff-Infant Ratio- (b) There shall be a ratio of one teacher for every four infants in attendance. This requirement was not met as evident by interviews conducted. Parent #1 stated they observed one teacher with more than four infants during pick up. This is an immediate risk to the health and safety of the children.
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Per Administrator, they will send out a memo to staff regarding Staff-Infant ratio and the steps the facility will take to prevent being out of ratio. Per Administrator, she will send a copy of the memo to LPA.

*Allegation has been amended 5/14/2020 to Unsubstantiated. No Deficiency cited.*
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*Allegation has been amended 5/14/2020 to Unsubstantiated. No Deficiency cited.*
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 54-CC-20200123165745
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: ST. TIMOTHY LUTHERAN INFANT CENTER
FACILITY NUMBER: 198005392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/23/2020
Section Cited
CCR
101427(j)(3)
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101427 Food Service- (j)(3)-Bottles and dishes provided by the authorized representative shall be rinsed and returned to the authorized representative for sanitizing at the end of each day.
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Per Administrator, Per Administrator, they will send out a memo to staff regarding this deficiency and the steps the facility will take to ensure that the parents are given the correct bottle. Per Administrator, she will send a copy of the memo to LPA.
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2020
LIC9099 (FAS) - (06/04)
Page: 6 of 6