198008836-7-15-2019-33-CC-CGAN-BEYUN6-20190812154327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198008836
Report Date: 07/15/2019
Date Signed: 07/15/2019 12:53:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2019 and conducted by Evaluator Ana Chico

COMPLAINT CONTROL NUMBER: 33-CC-20190604113822

FACILITY NAME:	MITRA FAMILY CHILD CARE		FACILITY NUMBER:	198008836
ADMINISTRATOR:	MITRA, SWETA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 393-5122
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91741
CAPACITY:	14	CENSUS: 3	DATE:	07/15/2019
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Mitra Sweta		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Operation of a Family Child Care Home: Child sustained a bump and cut to the head while in care.

INVESTIGATION FINDINGS:

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Ana Chico, Licensing Program Analyst (LPA) conducted an unannounced complaint inspection. LPA met with Sweta Mitra,licensee, who guided LPA on a tour of the facility. Licensee's Assistant was also present during the inspection. LPA explained that the purpose for the inspection is to provide findings to a pending complaint.
During the course of the investigation, LPA conducted staff, child and parent interviews. Also obtained were pictures of the injury. LPA found that on 6/3/19 child #1 received a cut and bump to the head after child #1 closed the trunk to the licensee's vehilcle on himself. According to licensee, on the date the injury occurred, she was in and out of the home as she was brining things inside from her car. During this time, licensee acknowledged that child #2 was with her as she was bringing things inside. Licensee admits that the door was left open and that the trunk had been closed without her knowledge when she went back outside. Though she never observed child #1 outdoors, other interviews found that child #1 and child #2 were indeed outside without supervision. Statements included eyewitness account that child #1 closed the trunk and hurt himself in the process. Though Assistant was present at the time the injury occurred, Assistant was caring for the younger children inside the home and did not see if both children were ever outdoors together. *****Report continues on an LIC 9099C..

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

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 33-CC-20190604113822

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MITRA FAMILY CHILD CARE	FACILITY NUMBER: 198008836
	VISIT DATE: 07/15/2019

NARRATIVE

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Based evidence obtained, which included interviews and pictures of the injury, the preponderance of evidence standard has been met, therefore the above allegation is being SUBSTANTIATED.

California Code of Regulations, Title 22 Section 102417(a) is being cited on the attached LIC 9099D. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A "Notice of Site Visit" and copy of the report was issued. Notice of Site Visit must remain posted for 30 days. Failure to do so will result in a $100.00 civil penalty. This report must remain on file for three (3) years. This report must be posted for 30 days in clear view. The report cannot be covered/concealed.

Exit interview conducted and a copy of this report was left with Sweta Mitra, license. A copy of this report and appeal rights were provided and explained. A "Notice of Site Visit" and copy of the report was issued. Notice of Site Visit must remain posted for 30 days. Failure to do so will result in a $100.00 civil penalty.

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20190604113822

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MITRA FAMILY CHILD CARE	FACILITY NUMBER: 198008836
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/19/2019 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	Operation of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement has not been met as evidenced by a confirmed cut and bump obtained by a day care child while in care and statements obtained during interviews which resulted	1 2 3 4 5 6 7	Licensee stated that she will provide a statement as to how she will ensure that all children are properly supervised.
	8 9 10 11 12 13 14	in an absence of supervision.This poses a 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: Katherine Harewood	TELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC9099 (FAS) - (06/04)

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