198016461-9-7-2023-54-CC-DGIS-CW2RJV-20230926130436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198016461
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:21:47 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
06/29/2023 and conducted by Evaluator Tiffanie Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20230629163640

FACILITY NAME:	KIDS FORUM PRESCHOOL		FACILITY NUMBER:	198016461
ADMINISTRATOR:	JANET TORRES		FACILITY TYPE:	850
ADDRESS:	4523 TWEEDY BLVD.		TELEPHONE:	(323) 563-6568
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	50	CENSUS: 9	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Janet Torres		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights-Facility staff left children without supervision.
License- Licensee is operating beyond the scope of their license.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs), T. Tran and A. Wallin arrived at the above facility to conduct a subsequent complaint inspection for the purpose of concluding for the aforementioned allegations. Upon arrival, LPAs met with Janet Torres, Center Director.
Based on records review and interviews were conducted, S1 and S2 admitted that sometime, staff stepped out of the classroom leaving the children unsupervised by any adults for no more than a minute. In addition, staff confirmed that during the week of 6/12/23-6/16/23 facility had enrolled two school age children in the preschool class. Therefore, based on the preponderance of evidence, the above allegations for personal rights and license were substantiated. A finding means that the complaint is substantiated and the allegation is valid because the preponderance of the evidence standard has been met.
Facility was cited type B deficiencies. Please see Complaint Investigation Report LIC 9099D for deficiency cited. A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the facility representative, Janet Torres.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 54-CC-20230629163640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDS FORUM PRESCHOOL	FACILITY NUMBER: 198016461
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/29/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision This requirement is not met as evidenced by based on record review and interview staff failed to protect children's personal rights by stepping out of the classroom leaving the children unsupervised for no more than a	1 2 3 4 5 6 7	9/7/23, LPA obtain the declaration statement of understanding not to repeat the same citation violation from the center director. In addition, director agrees to provide staff training for care and supervison and review policies and procedure then submit to
	8 9 10 11 12 13 14	minute which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	LPA with all staff signature in attendance and the training material by 9/29/23 to clear this citation.
Type B 09/29/2023 Section Cited CCR 101161(a)	1 2 3 4 5 6 7	limitations on license This requirement is not met as evidenced by based on record review and interview staff confirmed that during the week of 6/12//23-6/16/23 facility had enrolled two school age children in the preschool class	1 2 3 4 5 6 7	9/7/23, LPA obtain the declaration statement of understanding not to repeat the same citation violation from the center director. In addition, director agrees to provide staff training for care and supervison and review policies and procedure then submit to
	8 9 10 11 12 13 14	which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	LPA with all staff signature in attendance and the training material by 9/29/23 to clear this citation.

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: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
06/29/2023 and conducted by Evaluator Tiffanie Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20230629163640

FACILITY NAME:	KIDS FORUM PRESCHOOL		FACILITY NUMBER:	198016461
ADMINISTRATOR:	JANET TORRES		FACILITY TYPE:	850
ADDRESS:	4523 TWEEDY BLVD.		TELEPHONE:	(323) 563-6568
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	50	CENSUS: 9	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Janet Torres		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights-Licensee pushed child in care.
Personal Rights-Facility staff are not preventing children from engaging in physical altercations.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs), T. Tran and A Wallin arrived at the above facility to conduct a subsequent complaint inspection for the purpose of concluding for the aforementioned allegations. Upon arrival, LPA met with Janet Torres, Center Director.
During the course of the investigation, interviews were conducted with staff, children, and other it revealed that the allegations of center director pushed a child in care or staff failed to prevent children from engagin in physical altercation did not happened due to no witnesses observed the incident occurred at the facility. Therefore, the above personal rights allegations has been determined unsubstantiated. A finding that the complaint is unsubstantiated means that 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.
Exit interview conducted and report was reviewed with the facility representative, Janet Torres.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3