198018562-11-20-2019-33-CC-CGUA-BJKSM3-20191205125912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198018562
Report Date: 11/20/2019
Date Signed: 11/20/2019 03:42:25 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
08/26/2019 and conducted by Evaluator Cynthia Reyes

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20190826163440

FACILITY NAME:	COVINA DEVELOPMENT CENTER		FACILITY NUMBER:	198018562
ADMINISTRATOR:	JEPPSON, PAULA		FACILITY TYPE:	830
ADDRESS:	437 W. SAN BERNARDINO RD. #111		TELEPHONE:	(626) 967-7153
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	33	CENSUS: 13	DATE:	11/20/2019
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Sheena Yrma Minaya		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff-Infant Ratio-Facility is operating over ratio

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Cynthia Reyes and Roxana Lopez, arrived unannounced at the facility for the purpose of a follow up complaint Investigation regarding the allegation listed above. LPA met with Sheena Yrma Minaya, program manager and Paula Jeppson, Executive Director, who took LPA on a tour of the facility.

Based on LPA Interviews conducted and records reviewed and received, the preponderance of evidence standard has been met, therefore the above allegation of Staff-Infant Ratio, Facility is operating over ratio is found to be Substantiated. California Code of Regulations, Title 22 Health and Safety Code Section 1596.8595, is being cited on the attached LIC 9099-D. Per Interviews conducted and review of documents it was determined that the facility had 2 staff members left alone with 9 infant/toddlers due to 1 staff member came to work about 10 to 15 minutes late. Staff stated they notified the office and Director who stated she ended up going to the class room and moving the one extra child to another infant/toddler class room to have correct ratios.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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 3

Control Number 33-CC-20190826163440

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: COVINA DEVELOPMENT CENTER	FACILITY NUMBER: 198018562
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/20/2019 Section Cited CCR 101416.5(b)	1 2 3 4 5 6 7	Staff-Infant Ratio: There shall be a ratio of one teacher for every four infants in attendance.-This requirement is not met as evidenced by 2 staff members were left alone with 9 infant/toddlers because 1 staff came to work about 10/15 minutes late. This poses an immediate risk to the health and safety of children in care.	1 2 3 4 5 6 7	Director states will submit to the department a plan on how they will ensure ratio is met at all times. The plan should include more staff hired to cover late, sick or an emergency issue for the facility. Send copy of updated personnel report. Send plan and report as soon as possible.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 33-CC-20190826163440

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: COVINA DEVELOPMENT CENTER	FACILITY NUMBER: 198018562
	VISIT DATE: 11/20/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Upon receipt, Sheena Yrma Minaya, program manager posted the Notice of Site Visit and the 9099 D page (documentation of deficiencies.) This report and the Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months.

The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent.

LPA provided Sheena Yrma Minaya with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

Exit interview conducted with Sheena Yrma Minaya, program manager during which appeal rights were given and explained.

A copy of the Appeal Rights (LIC 9058 01/16) was provided. The program managers signature on this report acknowledges receipt of rights. Consultation was also conducted on this date.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3