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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198400455
Report Date: 09/17/2024
Date Signed: 09/17/2024 12:21:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
07/03/2024 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20240703123739
FACILITY NAME:LBUSD CARVER-CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198400455
ADMINISTRATOR:STEPHANIE STEPHENSFACILITY TYPE:
850
ADDRESS:5335 PAVO STTELEPHONE:
(562) 421-7015
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:24CENSUS: 0DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Coordinating Teacher-Theresa Basta TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff handled day care child in a rough manner
INVESTIGATION FINDINGS:
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This inspection was conducted by Licensing Program Analysts (LPAs) Jeanette Estrada and Portia Bowden. The purpose of this inspection is to deliver findings for the above allegation for the complaint received 7/3/24. Upon arrival there were no children present. The program morning session 8AM-11AM is from and the afternoon session is from 12PM-3PM. By the time LPAs left the facility, there were a total of 17 children present.

The complaint investigation was conducted in conjunction with the Community Care Licensing Investigation Branch (IB). IB Investigator, John Canto’s investigation consisted of interviews conducted with Child 1, parent of Child 1 and a review of records. LPA J. Estrada conducted interviews with staff and obtained and reviewed pertinent documents.
The investigation revealed that Staff 1 and Staff 2 removed Child 1 from the sit-down roller scooter while Child 1 resisted. Per staff interviewed, Child 1 was riding the tricycle when Child 2 expressed interest in the same toy.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 5
Control Number 54-CC-20240703123739
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LBUSD CARVER-CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198400455
VISIT DATE: 09/17/2024
NARRATIVE
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Staff 1 attempted to speak to Child 1 and explain that another child wanted to use the tricycle and Child 1 did not want to stop using the toy, therefore Staff 1 removed Child 1 from the tricycle with help from Staff 2.Interviews and records reviewed provided information that Staff 1 personally removed Child 1’s hands from the sit-down roller scooter's handlebars. Staff 1 stated that they gave Child 1 verbal prompts to get off the sit-down roller scooter, but Child 1 continued to stay on the tricycle. Per Staff 1, they waited about two minutes for Child 1 to get off the sit-down roller scooter and then proceeded to pick Child 1 up off the sit-down roller scooter. Per Staff 1, at this time Child 1 continued to grip the handlebars. This is when Staff 2 came over to assist by taking Child 1’s feet off the sit-down roller scooter. Staff 1 confirmed that Child 1 did not willingly let go of the toy. A few minutes after Child 1 was removed from the sit-down roller scooter, they expressed pain in their left arm. The parent of Child 1 took Child 1 to be medically examined. Medical records from ContinuEM Lakewood stated pain was likely a nurse’s maid elbow subluxation.

Other staff interviewed stated that in normal practice, they give warnings to children and will assist in removing them from a toy if they are in danger. Based on the information obtained from interviews, Child 1 did not want to share the tricycle, there was no sense of danger expressed by any of the staff.

The preponderance of evidence has been met, therefore the above allegations are found to be substantiated.



A type A deficiency is being cited today regarding regulation 101223(a)(1) for personal rights. The California Code of Regulations, (Title 22, Division 12, Chapter 1), is being cited on the attached LIC 9099D.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.


A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Coordinating Teacher, Theresa Basta.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
07/03/2024 and conducted by Evaluator Jeanette Estrada
COMPLAINT CONTROL NUMBER: 54-CC-20240703123739

FACILITY NAME:LBUSD CARVER-CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198400455
ADMINISTRATOR:STEPHANIE STEPHENSFACILITY TYPE:
850
ADDRESS:5335 PAVO STTELEPHONE:
(562) 421-7015
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:24CENSUS: DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Coordinating Teacher-Theresa Basta TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff caused injury to day care child
INVESTIGATION FINDINGS:
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This inspection was conducted by Licensing Program Analysts (LPAs) Jeanette Estrada and Portia Bowden. The purpose of this inspection is to deliver findings for the above allegation for the complaint received 7/3/24. Upon arrival there were no children present. The program morning session 8AM-11AM is from and the afternoon session is from 12PM-3PM. By the time LPAs left the facility, there were a total of 17 children present.
The complaint investigation was conducted in conjunction with the Community Care Licensing Investigation Branch (IB). IB Investigator, John Canto’s investigation consisted of interviews conducted with Child 1, parent of Child 1 and a review of records. LPA J. Estrada conducted interviews with staff and obtained and reviewed pertinent documents.
The investigation revealed that Staff 1 and Staff 2 removed Child 1 from the tricycle while Child 1 resisted. Per staff interviewed Staff 1 attempted to speak to Child 1 and explain that another child wanted to use the sit-down roller scooter and Child 1 did not want to stop using the it, therefore Staff 1 removed Child 1 from the sit-down roller scooter by removing Child 1’s fingers off the handlebars.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 54-CC-20240703123739
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LBUSD CARVER-CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198400455
VISIT DATE: 09/17/2024
NARRATIVE
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Per Staff 1, at this time Child 1 continued to grip the handlebars. Child 1 did not willingly let go of the handlebars. A few minutes after Child 1 was removed from the sit-down roller scooter, they expressed pain in their left arm. When the parent of Child 1 arrived, they noticed Child 1’s arm dangling. The parent of Child 1 took Child 1 to be medically examined. Medical records from ContinuEM Lakewood stated pain was likely a nurse’s maid elbow subluxation. Medical records did not state a cause of the injury.

Although Staff interviewed admitted to physically removing Child 1 from the sit-down roller scooter while child 1 resisted, there was no documented finding from medical professionals for the cause of the injury. Therefore the allegation that Facility staff caused injury to day care child Is unsubstantiated.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Coordinating Teacher, Theresa Basta.



SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 54-CC-20240703123739
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LBUSD CARVER-CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198400455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2024
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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LBUSD CDC will provide proof of training to staff regarding how to handle similar situations with children.
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This requirement is not met as evidenced by:
Based on interviews and record review the Licensee did not ensure that staff accorded dignity to the child as they physically removed child 1 from the scooter as child 1 resisted. This is an immediate risk to the personal rights for children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5