198018309-9-11-2019-33-CC-KCHS-BHY2NJ-20191115163250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198018309
Report Date: 09/11/2019
Date Signed: 09/11/2019 04:09:45 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
06/05/2019 and conducted by Evaluator Warren Birks

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20190605100006

FACILITY NAME:	SOUTH HILLS ACADEMY		FACILITY NUMBER:	198018309
ADMINISTRATOR:	CARLOS, KATHRYN		FACILITY TYPE:	850
ADDRESS:	1600 E. FRANCISQUITO AVE.		TELEPHONE:	(626) 919-2000
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	120	CENSUS:	DATE:	09/11/2019
		UNANNOUNCED	TIME BEGAN:	12:08 PM
MET WITH:	Michelle Clayton		TIME COMPLETED:	04:22 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced complaint inspection to investigate the above allegation. LPA met with Director Michelle Clayton who provided LPA with information.

LPA interviewed staff and inspected all classrooms (including restrooms, underneath and inside cabinets and drawers) and outdoor space. LPA observed no disrepair and the toilets functioning. There were disclosures from staff indicating a toilet was broken for approximately 3 weeks. However, maintenance attempted to repair the same day and had to order parts that required approval and additional time.

Maintenance later discovered the toilet couldn't be repaired (hairline fracture) and they had to order a new toilet which required approval and additional time. In the meantime, children were escorted to the restroom in the other class which is right next door and connected by a door (no hardship for the children).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

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-20190605100006

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: SOUTH HILLS ACADEMY	FACILITY NUMBER: 198018309
	VISIT DATE: 09/11/2019

NARRATIVE

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Based on interviews and documentation the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are unsubstantiated.

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 conducted with Director Michelle Clayton.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC9099 (FAS) - (06/04)

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