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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011690
Report Date: 01/21/2021
Date Signed: 01/21/2021 03:37:40 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
11/23/2020 and conducted by Evaluator Judy Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201123134236
FACILITY NAME:ST. ANNE'S EARLY LEARNING CENTERFACILITY NUMBER:
198011690
ADMINISTRATOR:VERONICA HERRERAFACILITY TYPE:
850
ADDRESS:151 N. OCCIDENTAL BLVD.TELEPHONE:
(213) 381-2931
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:90CENSUS: 24DATE:
01/21/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Amanda Velasquez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit child in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Judy Mora contacted the facility via telephone to conclude the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Mora identified herself and spoke to Associate Director, Amanda Velasquez and Amber Rivas, Chief Operations Officer. LPA discussed the purpose of the call.

During the course of the investigation, LPA conducted staff interviews and a child interview. No disclosures were made during interviews. LPA also obtained a copies of an ouch report, Identification and Emergency information form and sign in and out sheets. Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

*REPORT CONTINUES ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021
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 4
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
11/23/2020 and conducted by Evaluator Judy Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20201123134236

FACILITY NAME:ST. ANNE'S EARLY LEARNING CENTERFACILITY NUMBER:
198011690
ADMINISTRATOR:VERONICA HERRERAFACILITY TYPE:
850
ADDRESS:151 N. OCCIDENTAL BLVD.TELEPHONE:
(213) 381-2931
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:90CENSUS: 24DATE:
01/21/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Amanda Velasquez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child was injured while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Judy Mora contacted the facility via telephone to conclude the complaint investigation due to COVID-19 and pre-cautionary measures. LPA Mora identified herself and spoke to Associate Director, Amanda Velasquez and Amber Rivas, Chief Operations Officer. LPA discussed the purpose of the call.

During the course of the investigation, LPA conducted staff interviews and a child interview. No disclosures were made during interviews. LPA also obtained copies of an ouch report, Identification and Emergency information form and sign in and out sheets. Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

*REPORT CONTINUES ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20201123134236
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: ST. ANNE'S EARLY LEARNING CENTER
FACILITY NUMBER: 198011690
VISIT DATE: 01/21/2021
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
26
27
28
29
30
31
32
An exit phone interview has been conducted with Associate Director, Amanda Velasquez and Amber Rivas, Chief Operations Officer. Appeal Rights were verbally explained. A copy of this report has been signed by LPA Mora. This report along with the Appeal Rights will be scanned via e-mail to Associate Director, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report and the Appeal Rights will be mailed to the Associate Director who agrees to sign the bottom of each page of the 9099 and return the originals to LPA Mora in-person or via U.S. Mail.


*END OF REPORT
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20201123134236
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: ST. ANNE'S EARLY LEARNING CENTER
FACILITY NUMBER: 198011690
VISIT DATE: 01/21/2021
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
26
27
28
29
30
31
32
An exit phone interview has been conducted with Associate Director, Amanda Velasquez and Amber Rivas, Chief Operations Officer. Appeal Rights were verbally explained. A copy of this report has been signed by LPA Mora. This report along with the Appeal Rights will be scanned via e-mail to Associate Director, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. A hard copy of this report and the Appeal Rights will be mailed to the Associate Director who agrees to sign the bottom of each page of the 9099 and return the originals to LPA Mora in-person or via U.S. Mail.




*END OF REPORT
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4