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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198018562
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:15:48 PM

Unsubstantiated


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
06/20/2022 and conducted by Evaluator Thelma Razo
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220620145617
FACILITY NAME:COVINA DEVELOPMENT CENTERFACILITY NUMBER:
198018562
ADMINISTRATOR:SHEENA MINAYAFACILITY TYPE:
830
ADDRESS:437 W. SAN BERNARDINO RD. #111TELEPHONE:
(626) 967-7153
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:33CENSUS: 12DATE:
08/02/2022
UNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Yesenia Arteaga, Program ManagerTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Child had 6 head injuries in two months due to lack of supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Thelma Razo conducted a subsequent complaint visit to render findings on the allegation that a child had 6 injuries in two months due to lack of supervision.

On 6/28/2022, LPA did an on site visit to the center and toured two infant classrooms. LPA observed there were 2 staff in classroom 102A with 4 infants and 2 staff in classroom 102B with 5 children.

LPA interviewed 5 staff, 4 parents and an environmental health and safety specialist from Foothill Family Services.

Investigation has revealed that the subject child has had incidents like bumping of cheek and forehead resulting in redness and bruising of cheek and bumps on the forehead. Staff have witnessed the incidents but were not able to prevent injury as it happened quickly and unexpectedly. There were no statements that indicate that children in care were unsupervised. LPA observed children were being supervised during the on site visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
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-20220620145617
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: 08/02/2022
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview held, copy of report given to Program Manager Yesenia Arteaga
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2