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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198014073
Report Date: 09/02/2021
Date Signed: 10/13/2021 12:18:44 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
08/30/2021 and conducted by Evaluator Fabiola Vasquez
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20210830143227
FACILITY NAME:CAMELOT KIDS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198014073
ADMINISTRATOR:KATHERINE MANLYFACILITY TYPE:
850
ADDRESS:2880 ROWENA AVENUETELEPHONE:
(323) 662-2663
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:121CENSUS: 77DATE:
09/02/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Renae Plant, LicenseeTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility is not enforcing mask requirement.
INVESTIGATION FINDINGS:
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On 10/13/21 LPA Fabiola Vasquez amended the complaint report dated 09/02/21 to change the deficiency type.

Throughout the course of the investigation, interviews were conducted with Director, Renae Plant, and documentation in the form of a Face Covering Wavier (Form N) and a copy of a letter served to the LADPH and CDSS were obtained.

Pertaining to the allegation that “Facility is not enforcing mask requirement “this allegation refers to the facility not following the California Department of Public Health (CDPH) Guidance on the Use of Face Covering issued and updated June 29, 2021 as required. During the tour LPA observed 48 children outdoors, LPA observed 29 children indoors 16 of those children were not wearing mask.

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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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
Control Number 33-CC-20210830143227
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: CAMELOT KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198014073
VISIT DATE: 09/02/2021
NARRATIVE
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 LPA observed all 19 staff wearing mask. Per director own admission parents are provided a mask wavier form in the admission packet, the wavier has been provided to parents since July 15, 2021. Per director children are not wearing mask due to religious reasons and medical conditions. Per director they are trying to balance the development of the whole child such as children with autism, speech and emotional delays. Also, children that are in the spectrum.

LPA informed director that mask waivers do not exist. Current and future parents should not be provided with the wavier form to sign. There are mask exemptions, but these are medical exemptions signed off by a doctor or provider. Director was informed that children ages 2 and older are required to be wearing a mask indoors, and children must be encouraged to put them back on if and when the mask is not on correctly or it falls off. During the visit LPA provided the director with a box of disposable masks. Director was advised to contact their Local Resource and Referral agency for additional PPE.

Director was provided with website resources regarding face coverings. Director was advised to share website links with parents of children enrolled in preschool.

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Beyond-Blueprint.aspx

http://publichealth.lacounty.gov/acd/ncorona2019/masks/.

http://ph.lacounty.gov/acd/ncorona2019/EducationToolkit/ECE/. .

This agency has investigated the complaint alleging that "Facility is not enforcing mask requirement." that was regarding the director not enforcing the mask requirement for children wearing face coverings for children ages 2 and up. This is required by the CA Dept. of Public Health Guidance on the Use of Face Coverings updated June 29, 2021. LPA also addressed with director that an individual mask exemption did not exist unless the individual has a medical exemption signed off by a medical doctor or provider.

Based upon the evidence as listed above, the preponderance of evidence standard has been met and the allegation has been determined to be Substantiated. A finding of Substantiated means that the preponderance of evidence standard has been met. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 101223 "Personal Rights" is being cited on the attached LIC 9099D.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20210830143227
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: CAMELOT KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198014073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/20/2021
Section Cited
CCR
101223
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101223 Personal Rights: 2) To be accorded safe, healthful and comfortable accommodations, furnishings
and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Per director she will submit proof of children that have a face wavier exemption due to medical conditions.
By new POC date: 10/20/21
Director was advised to attend the Local Licensing Calls in the month of September and any future Local Licensing Calls for the rest of the year.

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Per directors own admission parents are provided a mask wavier, that was created by the director. During the visit 29 children were observed indoors, 16 of those children were not wearing mask.

This poses a potential risk to the health and safety of 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20210830143227
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: CAMELOT KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198014073
VISIT DATE: 09/02/2021
NARRATIVE
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Deficiencies that are being cited need to be cleared to protect the health and safety of children in care.

A type B is being cited.

Please refer to 9099D for documentation of deficiencies.

This report along with Appeal Rights were sent through certified mail and regular mail. The Notice of Site Visit was not provided since the report was mailed.


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4