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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011765
Report Date: 01/11/2021
Date Signed: 01/12/2021 09:04:53 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
08/25/2020 and conducted by Evaluator Alicia Mooberry
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20200825082406
FACILITY NAME:ANTONINI FAMILY CHILD CAREFACILITY NUMBER:
198011765
ADMINISTRATOR:ANTONINI, MARLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 420-2396
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:14CENSUS: 10DATE:
01/11/2021
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Marla Antonini, LicenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a complaint inspection on 01/11/21 at 2:35 PM. Due to COVID-19 and precautionary measures this inspection was conducted via video conference. The purpose of the tele-inspection was to deliver the findings for the above allegation. LPA met with Marla Antonini, Licensee, who provided video tour of facility, there were 10 children present during the inspection as well as Cesilia Arambula, assistant.
During the course of the investigation interview were conducted with the licensees and documentation was collected.
Reporting party stated that facility is over-capacity. Licensee stated facility was over capacity in July 2020. Licensee provided written statement and report from Child Lane confirming the above allegation.
Based on disclosure made by licensee and documentation collected, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

Report continues on LIC 812C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
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 3
Control Number 54-CC-20200825082406
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: ANTONINI FAMILY CHILD CARE
FACILITY NUMBER: 198011765
VISIT DATE: 01/11/2021
NARRATIVE
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California Code of Regulations, 102416.5 Staffing Ratio and Capacity, is being cited on the attached LIC. 9099D
Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).


Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

Exit interview was conducted via video conference with Marla Antonini, licensee and a copy of this report was signed by LPA Alicia Mooberry. This report sent via email to licensee and an electronic read receipt confirms receiving the report. Appeal Rights were discussed and provided.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20200825082406
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: ANTONINI FAMILY CHILD CARE
FACILITY NUMBER: 198011765
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2021
Section Cited
CCR
102416.5(a)(g)
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(a)The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. (g)...for a school age child who is under age six, the licensee shall maintain documentation verifying the child’s enrollment and attendance at kindergarten..., or elementary school.
This requirement is not met as evidenced by:
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Licensee submitted a written declaration stating how she will ensure facility complies with capacity specified on license.
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Based on Licensee's own admission of overcapacity to and documentation obtained.
This poses an immediate helat and safety risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3