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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198017331
Report Date: 12/19/2019
Date Signed: 12/19/2019 12:05:37 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
08/08/2019 and conducted by Evaluator Jennifer Hua
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20190808151011
FACILITY NAME:KIDDIE ACADEMY OF DIAMOND BARFACILITY NUMBER:
198017331
ADMINISTRATOR:ELIZABETH MILLERFACILITY TYPE:
830
ADDRESS:21385 COLD SPRING LANETELEPHONE:
(909) 979-3808
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:32CENSUS: 17DATE:
12/19/2019
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Gina WilsonTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Daycare child sustained a suspicious injury which required medical attention.
INVESTIGATION FINDINGS:
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This complaint inspection was conducted by Licensing Program Analyst (LPA) Jennifer Hua who met with director, Gina Wilson for the purpose of providing the finding for the above pending allegation.

During the course of the investigation conducted by IB Investigator Lorraine Patterson, interviews were conducted with day-care staff as well as the reporting party. Documents from local law enforcement were also obtained and reviewed. Child's medical records and camera footage were also reviewed. Day-care children including the victim were not interviewed due to their age.

Staff and subject of the investigation, denied having witnessed any staff, including staff #1, hurt child #1 or any other day-care child enrolled. Interviews, lack of witnessses, supporting evidence and documents obtained as to how the alleged injury occurred were reviewed. Although the allegation may have happened or is valid, there is not a preponderence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 2
Control Number 33-CC-20190808151011
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 DIAMOND BAR
FACILITY NUMBER: 198017331
VISIT DATE: 12/19/2019
NARRATIVE
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The notice of site visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with the Director, during which appeal rights were explained. A copy of the appeal rights (LIC 9058 01/16) were provided. The Director signature on this report acknowledges receipt of her rights.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2