198015371-12-18-2024-33-CC-ACHO-DCPPY3-20250107104314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198015371
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:56:38 PM

Substantiated

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
11/01/2024 and conducted by Evaluator Carolyn Tuba

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20241101121218

FACILITY NAME:	BAILEY FAMILY CHILD CARE		FACILITY NUMBER:	198015371
ADMINISTRATOR:	BAILEY, KIM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 369-6494
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	14	CENSUS: 8	DATE:	12/18/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kim Bailey		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Infant sustained an injury that required tooth removal

INVESTIGATION FINDINGS:

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On 12/18/2024 at 10:40 am Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced inspection to deliver findings for a complaint. A Covid risk assessment was completed. LPA met with Licensee, Kim Bailey. LPA took a census of 8 children with 2 adults.

LPA interviewed Reporting Party (RP). LPA conducted investigation visit on 11/07/2024. Interviews were conducted with Licensee, and Staff #1 (S1), Child #2 (C2), and #3 (C3). LPA was unable to interview Child #1 (C1) due to age of child and Child #4 (C4) did not qualify during the interview process.

Reporting Party alleges that Infant sustained an injury that required tooth removal. LPA interviewed Licensee and S1 who both disclosed that C1 had jumped onto a beanbag chair located in the playroom and this occurred on 10/25/2024 at approximately 11:00 am. During the investigation visit on 11/07/2024 LPA, Tuba requested that S1 place the beanbag chair in the exact location where the injury occur. LPA
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

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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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
11/01/2024 and conducted by Evaluator Carolyn Tuba

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20241101121218

FACILITY NAME:	BAILEY FAMILY CHILD CARE		FACILITY NUMBER:	198015371
ADMINISTRATOR:	BAILEY, KIM		FACILITY TYPE:	810
ADDRESS:	420 DIXFORD LANE		TELEPHONE:	(626) 369-6494
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	14	CENSUS: 8	DATE:	12/18/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kim Bailey		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee failed to report infant's injury to parent

INVESTIGATION FINDINGS:

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On 12/18/2024 at 10:40 am Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced inspection to deliver findings for a complaint. A Covid risk assessment was completed. LPA met with Licensee, Kim Bailey. LPA took a census of 8 children with 2 adults.

LPA interviewed Reporting Party (RP). LPA conducted investigation visit on 11/07/2024. Interviews were conducted with Licensee, and Staff #1 (S1) Child #2 (C2), and #3 (C3). LPA was unable to interview Child #1 (C1) due to age of child and Child #4 (C4) did not qualify during the interview process.

Reporting Party alleges Licensee failed to report infant's injury to parent. LPA interviewed the licensee and S1 who both disclosed that the parent who picked up C1 on 10/25/2024 at approximately 4:30 pm was told of the injury in person and was given an incident report of the injury. LPA received a copy of the parent incident report and there is a section which allows for a parent signature but was not filled out. There were no
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

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-20241101121218

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: BAILEY FAMILY CHILD CARE	FACILITY NUMBER: 198015371
	VISIT DATE: 12/18/2024

NARRATIVE

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texts or emails available that demonstrates proof of communication. The only communication available via text by the Licensee was the parent who stated that the tooth was going to be removed on Saturday, October 26, 2024. The LPA advised that best practice is the Licensee should have parent sign their incident report or that they send a communication via text so that it has a date and time stamp.

During the course of interviews and based on the evidence obtained during the course of the investigation, the evidence does not support, nor disprove the above allegation that Licensee failed to report infant's injury to parent. Therefore, the allegation has been determined to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Kim Bailey.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20241101121218

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: BAILEY FAMILY CHILD CARE	FACILITY NUMBER: 198015371
	VISIT DATE: 12/18/2024

NARRATIVE

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took a photo of the beanbag chair and its location. S1 stated that she had witnessed C1 jump onto the beanbag chair and had cried. Soon after the injury Licensee disclosed that she had looked at C1’s mouth area and did not see any bleeding or swollenness and C1’s teeth seem to be fine. According to the Licensee no first aid was necessary. C2 and C3 did not make any disclosures. LPA received photos and documentation that the tooth was extracted by a dental professional from C1’s mouth. During this investigation LPA researched the exact same beanbag chair and discovered that the recommended age for the use of this beanbag chair is from age 3 to 7 years. LPA provided a copy to the Licensee for reference.

Based on the disclosure made by the Licensee and S1 that an injury did occur during the care of C1 at the family child care home on 10/25/2024 and the recommended age of the beanbag chair, compared to the age of C1, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

The following deficiency listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Kim Bailey.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20241101121218

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: BAILEY FAMILY CHILD CARE	FACILITY NUMBER: 198015371
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/18/2024 Section Cited CCR 102417(d)	1 2 3 4 5 6 7	102417 Operation of a Family Child Care Home (d) The home shall provide safe toys, play equipment and materials.	1 2 3 4 5 6 7	Licensee has removed the beanbag chair and LPA consulted with Licensee that moving forward she will check any items used in the child care daycare are age appropriate. Such as toys, play equipment or furniture.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews with licensee, staff #1 and record review that child who was 1 years old was hurt due to jumping on beanbag chair that was not age appropriate. This poses a potential Health and Safety Risk to 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: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

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