198011002-3-1-2022-54-CC-VCOK-CC5PUT-20220302103801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198011002
Report Date: 03/01/2022
Date Signed: 03/01/2022 02:36:05 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
11/01/2021 and conducted by Evaluator Alicia Mooberry

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20211101135709

FACILITY NAME:	LOS ANGELES ADVENTIST ACADEMY		FACILITY NUMBER:	198011002
ADMINISTRATOR:	JACQUELINE GALBREATH		FACILITY TYPE:	850
ADDRESS:	846 E.EL SEGUNDO BOULEVARD		TELEPHONE:	(323) 743-8818
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	40	CENSUS: 16	DATE:	03/01/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cassandra Hudson-Johnson, Acting Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced complaint inspection on 3/1/22. LPA arrived at the facility at 1:30pm. LPA met with Cassandra Hudson-Johnson, Acting Director, to deliver the findings for the above allegation. LPA toured the facility at 1:34pm. LPA observed, 16 children, and 1 staff members present during the inspection.
This investigation was conducted along with Community Care Licensing Investigations Branch (IB) Investigator. IB investigator conducted interviews with Child #1, Adult #1 and Los Angeles Sheriff’s Detective. A forensic interview was conducted.
During forensic interview Child #1 did not report any abuse. There was no medical evidence of abuse found during the medical exam.
Additionally, LPA conducted interviews with the director, facility staff, children and witnesses. Interviews conducted did not corroborate allegation that a child’s personal rights were violated while in care.
Report continues on 9099C

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: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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-20211101135709

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: LOS ANGELES ADVENTIST ACADEMY	FACILITY NUMBER: 198011002
	VISIT DATE: 03/01/2022

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Cassandra Hudson-Johsnon, Acting Director

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC9099 (FAS) - (06/04)

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