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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017158
Report Date: 06/08/2021
Date Signed: 06/08/2021 09:37:44 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
05/03/2021 and conducted by Evaluator Rita Ramos
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20210503125114
FACILITY NAME:ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORAFACILITY NUMBER:
198017158
ADMINISTRATOR:OLA BAILEYFACILITY TYPE:
850
ADDRESS:2590 INDUSTRY WAYTELEPHONE:
(310) 669-9440
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:40CENSUS: 20DATE:
06/08/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ola Bailey, Site SupervisorTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Staff spanked child

Facility failed to report incident to parent in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced inspection on 06/08/21 at 8:30 AM. The purpose of the inpection was to investigate the above allegations. LPA met with Ola Bailey, Site Supervisor, who guided LPA on a tour of the facility. There were 20 children and 3 other staff present during the inspection.

During the investigation LPA obtained copies of the facility roster, staff roster, supporting documentation, pictures, and conducted interviews.

Information provided by the reporting party indicates that Staff #2 violated Child #1’s personal rights and the facility failed to inform Child #1’s parent of the incident in a timely manner.

Staff were interviewed during the investigation. Staff #3 disclosed that they observed Staff #2 violate Child #1’s personal rights. ----Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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-20210503125114
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: ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORA
FACILITY NUMBER: 198017158
VISIT DATE: 06/08/2021
NARRATIVE
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Staff #2 disclosed that in playing with Child #1 they violated child’s personal rights. Staff #1 disclosed that Staff #2 admitted to violating child’s personal rights and parent was not informed of the incident in a timely manner.

Children were interviewed during the investigation.

Based on LPAs interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 101223(a)(3) Personal Rights and 101212(f) Reporting Requirements, are being cited on the attached deficiencies page.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the 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. Exit interview was conducted with Ola Bailey, Site Supervisor, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

----Page 2 of 2

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20210503125114
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: ELLA FITZGERALD CDC/DREW CHILD DEVELOPMENT CORPORA
FACILITY NUMBER: 198017158
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/22/2021
Section Cited
CCR
101223(a)(3)
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Personal Rights

(a) The licensee shall ensure that each child is accorded the following personal rights:

(3)To be free from corporal or unusual punishment, infliction of pain humiliation, intimidation, ridicule, coercion, threat,...
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Per Site Supervisor, all staff is pending a meeting to discuss personal rights and stress management. Certificates and agendas of the trainings will be submitted by POC due date of 06/22/21.
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This requirement is not met as evidenced by disclosures made that Child #1's personal rights were violated by Staff #2. Due to Staff #2 no longer employed at the facility, therefore, no longer and immediate threat, this poses a potetnial health and safety risk to children in care.
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Type B
06/08/2021
Section Cited
CCR
101212(f)
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Reporting Requirements

(f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.
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Per Site Supervisor, the Program Director will conduct a training on reporting requirements which will include parent's rights. Proof of the training will be submitted by POC due date of 06/22/21.
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This requirement is not met as evidenced by disclosures made that staff failed to report the incident to Child #1's parent in a timely manner. This poses a potential health 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: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3