198019554-10-20-2022-33-CC-ACHO-CKKNY2-20221026105200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198019554
Report Date: 10/20/2022
Date Signed: 10/20/2022 10:45:54 AM

Substantiated

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
10/14/2022 and conducted by Evaluator Jennifer Hua

PUBLIC

COMPLAINT CONTROL NUMBER: 33-CC-20221014144800

FACILITY NAME:	AZUSA ISD-W.R. POWELL CSPP		FACILITY NUMBER:	198019554
ADMINISTRATOR:	LESLIE FORD		FACILITY TYPE:	850
ADDRESS:	1035 E. MAUNA LOA AVENUE		TELEPHONE:	(626) 815-4700
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	60	CENSUS: 17	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Maria Garcia		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Facility is operating out of ratio

INVESTIGATION FINDINGS:

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Complaint inspection conducted by Licensing Program Analyst (LPA) Jennifer Hua. LPA arrived to the Powell Elementary School parking lot at 8:55am. LPA walked to the school office to sign in and was directed to room K1. LPA arrived to room K1 at 9:03am. LPA met with Site Supervisor Maria Garcia. A Covid-19 risk assessment was conducted. LPA informed site supervisor the purpose of the visit. LPA reviewed allegation with site supervisor. At the time of LPA's arrival, LPA observed 17 chlldren present with site supervisor and 1 staff. Per site supervisor, the 17th child arrived at 8:18am making the facility out of ratio for almost an hour. LPA observed a third staff arrived at 9:11am.

Interview conducted with staff.

S1 confirmed that the facility was also out of ratio on 10/13/2022. S1 stated that on 10/13/22, there were 16 children supervised by S1. A second staff was present to assist during arrival, breakfast and dismissal.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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-20221014144800

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: AZUSA ISD-W.R. POWELL CSPP	FACILITY NUMBER: 198019554
	VISIT DATE: 10/20/2022

NARRATIVE

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This agency has investigated the complaint alleging facility is operating out of ratio. Based on observation and interview which was conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 5 are being cited on the attached LIC 9099D.

Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this visit.

Exit interview was conducted with Site Supervisor, Maria Garcia, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. .

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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Control Number 33-CC-20221014144800

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: AZUSA ISD-W.R. POWELL CSPP	FACILITY NUMBER: 198019554
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/21/2022 Section Cited CCR 101216.3(c)(1)(C)	1 2 3 4 5 6 7	Teacher-Child Ratio. Child development programs funded by the California Department of Education and operating under Title 5 of the California Code of Regulations are not required to meet the teacher-child ratios specified in (a) and (b) above. Title 5 staffing ratios shall apply in such centers. Preschool	1 2 3 4 5 6 7	Per Site Supervisor, the district has been trying to hire more staff. Licensee shall submit a plan of correction to ensure compliance at all times. Deficiency corrected duirng visit.
	8 9 10 11 12 13 14	(36 months to enrollment in kindergarten) - 1:8 adult-child ratio, 1:24 teacher-child ratio. The requirement is not met as evidenced by: LPA observed 17 children with 2 staff upon arrival. Staff also confirmed facility was also out of ratio on 10/13/22. This is poses an immdediate health and safety of children in care.	8 9 10 11 12 13 14
	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: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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