304310224-9-8-2021-06-CC-RLOZ-C7CNK6-20210930103125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304310224
Report Date: 09/08/2021
Date Signed: 09/08/2021 11:57:28 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/31/2021 and conducted by Evaluator Pat Rivas

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20210831103113

FACILITY NAME:	KELLY, TATIANA		FACILITY NUMBER:	304310224
ADMINISTRATOR:	KELLY, TATIANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 337-8394
CITY:	LAHABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	14	CENSUS: 9	DATE:	09/08/2021
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Tatiana Kelly, Licensee		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee did not report injury to child's parent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) P Rivas conducted an unannounced complaint visit to investigate the above allegation. Upon arrival LPA met with licensee Tatiana Kelly and discussed the purpose of the inspection.
On 08/31/2021, Licensing office received a complaint alleging licensee failed to report an injury to child's parent.

During the tour of the facility, at 08:45 AM, LPA Rivas observed 9 toddlers and 2 staff members(includes licensee). in the designated day care area. A third staff arrived during walk through. Based upon LPA's observation Licensee is operating within the licensed capacity as specified on license.

A review of the Facility Personnel Report Summary on this date 09/08/2021 at 09:00 AM indicated all facility staff present or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The investigation consisted of Children file reviews; 1 of 9 files was reviewed. One (1)Licensee interview, Interview with One (1) parent. Interview with one (1) community member. Staff #3 and volunteer who were

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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 06-CC-20210831103113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KELLY, TATIANA	FACILITY NUMBER: 304310224
	VISIT DATE: 09/08/2021

NARRATIVE

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present on 08/23/21 were not available for interview.

The investigation found;
On 08/23/21 Child#1(C1) sustained a small red mark to his/her head and no one from the facility brought it to C1's parent's attention.
Interview with C1's parent On 08/24/21; C1's parent noticed mark, which " had red mark which began to look like it was a scab" after pick up. Parent was not notified of any injury or issue on 08/23/21, only after 08/24/21 pick up and only after she brought it to the Licensee's attention.

On 09/08/21 at 9:00am licensee reported that she had spoken with Child #1's Parent about incident that occurred on 08/23/21. Licensee admitted C1;s Parent is the person who brought the issue to light and she had not spoken to C1's parent until 08/24/21 about the incident. Licensee reports after speaking with her staff it was it was found that C1 had complained to staff about having issue with C2. Per licensee her staff stated, the mark sustained was small and red on Monday but on Tuesday it had little red dots. Furthermore licensee stated that staff did not advise her nor parent of issue.

Review of Child's file on 09/08/21 at 9:30 did not show any documentation of incident that occurred on 08/23/21.

On 09/08/21 from approximately 9:40 to 10:40 LPA and Licensee reviewed video recordings of daycare designated area inside and outside directly in front of outside entrance into designated area. The video inside the designated area was unable to play back from 4:55pm to 6:00pm . Portion of recordings viewed by LPA and Licensee showed C1 having normal interaction with other children in facility.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12 and Chapter 1 is being cited on the attached LIC 9099D.
Appeal Rights and the appeal rights process was discussed with the licensee. The licensee was informed all appeals must be in writing and received by the licensing office within 15 business days. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20210831103113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KELLY, TATIANA	FACILITY NUMBER: 304310224
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/09/2021 Section Cited CCR 102416.2(f)1	1 2 3 4 5 6 7	Reporting Requirements As soon as possible but no later then the same business day, the licensee shall notify a child's parent or authorized rep. regardless of the injuries or acts that affect that child as specified in Health and Safety Code Section 1597.467(a). Any injury suffered by a child in	1 2 3 4 5 6 7	Licensee reports she will begin to use an ouch report and have a blank copy of report and a completed report for incident of 08/23/21 to LPA by plan of correction date via email patricia.rivas@dss.ca.gov
	8 9 10 11 12 13 14	care shall be reported to that child's parent or authorized representative regardless of treatment by a medical professional.This Requirement was not met as evidenced by Licensee's statement that she nor her staff notify C1's parent of injury sustained,& review of C1's record This poses a potential hazard to 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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

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