198019107-7-8-2019-54-CC-ACHO-BHXU8G-20191115142129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019107
Report Date: 07/08/2019
Date Signed: 07/08/2019 12:36:00 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 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
07/02/2019 and conducted by Evaluator Justin Dorsey

COMPLAINT CONTROL NUMBER: 54-CC-20190702085649

FACILITY NAME:	GOLDEN CITY CHILD DEVELOPMENT CENTER INC.		FACILITY NUMBER:	198019107
ADMINISTRATOR:	ANGELICA HERRERA		FACILITY TYPE:	840
ADDRESS:	812 E. CARSON ST.		TELEPHONE:	(310) 634-5664
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	15	CENSUS:	DATE:	07/08/2019
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:			TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Lack of supervision resulting in child sustaining an injury while under the care of the facility.
Child had access to hazardous object.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dorsey conducted an unannounced complaint investigation to investigate a complaint that was received on 07/02/19. LPA met with Director, Angelica Herrera who gave a tour of the facility.

Census: School-age Classroom: Staff #1 and Staff #2 with 9 children.

During this investigation LPA conducted interviews with the Director, staff members, and children, observation was conducted, and criminal record clearances were reviewed. LPA also obtained facilities roster and sign in sheets from 07/08/19 and 06/27/19. LPA also obtained the email which was sent on 07/01/19 to the facilities LPA regarding the unusual incident. Facility sent an email to their LPA but the LIC 624 was not attached. A copy of the LIC 624 was also obtained by LPA Dorsey.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

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 54-CC-20190702085649

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: GOLDEN CITY CHILD DEVELOPMENT CENTER INC.	FACILITY NUMBER: 198019107
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/22/2019 Section Cited CCR 101238.2(d)(2)	1 2 3 4 5 6 7	101238.2 Outdoor Activity Space (d)(2) The surface of the outdoor activity space shall be maintained free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The facility will keep the gate to the storage area locked at all times so that it is inaccessible to the children. The facility will scan the storage area and other parts of the playground regularly to make sure that there is no objects that can injure children. The facility plans to install a net so that basketballs can not bounce into the storage area.
	8 9 10 11 12 13 14	Based on observation and interview on 06/27/19 the facility had a child fall and cut his arm on a piece of broken glass while getting a basketball in the storage area, which poses an immediate Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14
Type A 07/22/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Outdoor Activity Space (a)(1) The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The facility will make sure that the children in care are supervised at all times. Per director the staff will make sure the children no longer go into the storage area to get basketballs. The facility will also get all items necessary out of the storage are in the morning so that the storage area can remain locked throughout the day.
	8 9 10 11 12 13 14	Based on observation and interview on 06/27/19 the facility had a child go into the storage area unsupervised resulting in a injury, which poses an immediate Health, Safety or Personal Rights risk to children in care.	8 9 10 11 12 13 14

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: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20190702085649

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: GOLDEN CITY CHILD DEVELOPMENT CENTER INC.	FACILITY NUMBER: 198019107
	VISIT DATE: 07/08/2019

NARRATIVE

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Based on LPA observations and interviews with staff, it was found that a child fell and cut his arm on a piece of glass while in the facilities storage area retrieving a basketball. It was also discovered during interviews that at the time of the injury the child was unsupervised.

Based on LPAs observations and interviews which were conducted and record review the preponderance of evidence standard has been met, therefore the above allegations is found to be substantiated. California Code of Regulations, (Title 12, Division 1 & Chapter 1), are being cited on the attached LIC 9099 D.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to the Licensee.

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.

An exit interview was conducted with, and a copy of this report has been signed by and provided to Director Angelica Herrera, appeal rights were given.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

LIC9099 (FAS) - (06/04)

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