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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198016424
Report Date: 10/29/2021
Date Signed: 10/29/2021 05:05:20 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
08/03/2021 and conducted by Evaluator Cynthia Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20210803124053
FACILITY NAME:KIDDIE ACADEMY OF GLENDORAFACILITY NUMBER:
198016424
ADMINISTRATOR:BETH HOLMESFACILITY TYPE:
840
ADDRESS:1339 SOUTH GRAND AVENUETELEPHONE:
(626) 691-0242
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:27CENSUS: 0DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alexis GodinezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility staff not properly wearing mask.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced follow up complaint inspection to present the findings of the complaint. LPA met with Alexis Godinez, Director who took LPA on a tour of the facility. During this walk through, LPA observed no staff or children in the school age class room at this time. Director stated today is the schools Halloween festivities, also the school age children will arive between 1-2PM from there regular school.

School age children arrived at 1PM. Census of school age children were taken; staff names and positions were documented.

During the course of the inspection LPA conducted interviews with the staff, children and witnesses, reviewed and received records. Based on the available information and the LPAs own observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 1), are being cited on the attached LIC. 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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 6
Control Number 33-CC-20210803124053
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: KIDDIE ACADEMY OF GLENDORA
FACILITY NUMBER: 198016424
VISIT DATE: 10/29/2021
NARRATIVE
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On 08/10/2021 the initial 10 day complaint inspection was conducted. During the walk through of the facility with the assistant director Nicole, both LPA and Nicole observed of the 15 staff present in the facility, 5 staff were not wearing their face mask properly as it was observed to be worn under their nose. LPA had also observed Nicole the Assistant Director wearing her face mask under her nose upon arrival and during the walk though of the inspection. Per interviews with staff, some stated their mask slip off their noses and its hard to keep it on completely.

The above allegation of Facility staff not properly wearing mask is found to be Substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 1), are being cited on the attached LIC. 9099D.

Exit interview was conducted with Director, Alexis Godinez. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the days and 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 33-CC-20210803124053
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: KIDDIE ACADEMY OF GLENDORA
FACILITY NUMBER: 198016424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful & comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:
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Director sent LPA copies of mask wearing posters she has placed in and around the facility as well as had all staff sign and date a statement regarding wearing a mask in the facility. Director will update the signed statements to reflect that they will wear mask and will wear them properly. Director will also update the signed document to reflect
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Per LPAs own observation of some of the staff wearing their mask under their nose, including the assistant director and per interviews with staff, some stated their mask slip off their noses and its hard to keep it on completely. This poses a potential risk to the health and safety of children in care
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that this is a requirement by the California Department of Public Health (CDPH) Guidance on the Use of Face Covering and a personal rights issue under title 22 regulations.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
08/03/2021 and conducted by Evaluator Cynthia Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20210803124053

FACILITY NAME:KIDDIE ACADEMY OF GLENDORAFACILITY NUMBER:
198016424
ADMINISTRATOR:BETH HOLMESFACILITY TYPE:
840
ADDRESS:1339 SOUTH GRAND AVENUETELEPHONE:
(626) 691-0242
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:27CENSUS: 0DATE:
10/29/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Alexis GodinezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility staff not doing temperature checks on daycare children.
Staff handled daycare child in a rough manner resulting in an injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced follow up complaint inspection to present the findings of the complaint. LPA met with Alexis Godinez, Director who took LPA on a tour of the facility. During this walk through, LPA observed no staff or children in the school age class room at this time. Director stated today is the schools Halloween festivities, also the school age children will arive between 1-2PM from there regular school.

School age children arrived at 1 PM. Census of school age children were taken; staff names and positions were documented.

During the course of the inspection LPA conducted interviews with staff, children and witnesses, reviewed and received records. Based on the available information and the LPAs own observations, and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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 6
Control Number 33-CC-20210803124053
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: KIDDIE ACADEMY OF GLENDORA
FACILITY NUMBER: 198016424
VISIT DATE: 10/29/2021
NARRATIVE
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Page 2

There were no statements made to corroborate with the above allegation. During Interviews with staff, it was said that they are in the class room so they never see if a child temperature is being taken or not, because office staff greet the children at the front door where temperature is to be taken and documented before being taken to the class room. Director provided LPA with some copies of temperature logs of children. Other interviews stated that the children don't always or never have there temperature taken. It is also not know if the temperature log is filled out after the child is taken to the class room because it was observed that the child was just walked to the class room and nothing documented or temperature was taken.

Interviews were conducted, and it was stated that children would complain about the child that got a scratch that he was mean to other children, Staff stated no child has ever been handled in a rough manner resulting in an injury to a child. It was stated that a staff member was playing with a child, by swinging the child's arms, resulting in the staff members ring scratching the child's face. Interviews stated that, yes a staff member was sitting on a chair and was 7 months pregnant at the time and a child grabbed her hands and started swinging them and the staff moved her hands to ensure the child or herself did not get hurt and it ended up that the staff may have touched the child's face, however it was thought to have been the child hitting himself with his own hand and not her hand with a ring on.

An exit interview was conducted with Alexis Godinez. Appeal rights were explained and provided. The Notice of Site Visit was issued and must be posted for 30 days failure to do so will result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6