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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360906560
Report Date: 01/29/2020
Date Signed: 02/25/2020 05:34:04 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2020 and conducted by Evaluator Taadhimeka Zeigler
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20200107164912
FACILITY NAME:SAN BERNARDINO CITY SCHOOL DIST.-ALLDRED CHILD DEFACILITY NUMBER:
360906560
ADMINISTRATOR:KELLY, LATASHIAFACILITY TYPE:
850
ADDRESS:303 S. K STREETTELEPHONE:
(909) 388-6307
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY:150CENSUS: 100DATE:
01/29/2020
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Latashia KellyTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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9
Facility staff failed to seek medical attention for the child in a timely manner.
INVESTIGATION FINDINGS:
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***Amended from the LIC9099C delivered on 01/29/2020***
Licensing Program Analyst (LPA) Taadhimeka Zeigler arrived at the facility to conduct an investigation into the above allegation. LPA met with Director, Latashia Kelly, the purpose of the visit was discussed. LPA toured the facility and the census was taken.

The initial investigation visit was conducted on 01/15/2020. The investigation included the review of pertinent documention, and staff interviews.

Regarding the allegation that facility staff failed to seek medical attention for the child in a timely manner, interviews revealed that following the incident of Child #1 falling, the facility staff, who are CPR/1st Aid certified, assessed Child #1. It was determined that Child #1 did not require medical attention beyond 1st Aid.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2020 and conducted by Evaluator Taadhimeka Zeigler
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20200107164912

FACILITY NAME:SAN BERNARDINO CITY SCHOOL DIST.-ALLDRED CHILD DEFACILITY NUMBER:
360906560
ADMINISTRATOR:KELLY, LATASHIAFACILITY TYPE:
850
ADDRESS:303 S. K STREETTELEPHONE:
(909) 388-6307
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY:150CENSUS: DATE:
01/29/2020
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Latashia KellyTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to provide the child's authorized representative with an incident report.
INVESTIGATION FINDINGS:
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3
4
5
6
7
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9
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12
13
Licensing Program Analyst (LPA) Taadhimeka Zeigler arrived at the facility to conduct an investigation into the above allegation. LPA met with Director, Latashia Kelly, the purpose of the visit was discussed. LPA toured the facility and the census was taken.

The initial investigation visit was conducted on 01/15/2020. The investigation included the review of pertinent documention, and staff interviews.

Regarding the allegation that the facility staff failed to provide the child's authorized representative with an incident report, interviews with staff disclosed that Child #1's parent was contacted regarding an unusual incident, however, facility staff was unable to provide proof that a written incident report was provided to Child #1's authorized representative.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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 09-CC-20200107164912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SAN BERNARDINO CITY SCHOOL DIST.-ALLDRED CHILD DE
FACILITY NUMBER: 360906560
VISIT DATE: 01/29/2020
NARRATIVE
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Therefore, based on interviews and the information obtained, the allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

See LIC 9099D for deficiency cited.

An exit interview was conducted with the Director, Appeal Rights were discussed and issued, a copy of this report was provided, and a Notice of Site visit was issued and posted.



A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 09-CC-20200107164912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN BERNARDINO CITY SCHOOL DIST.-ALLDRED CHILD DE
FACILITY NUMBER: 360906560
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2020
Section Cited
CCR
101173(d)
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Plan of Operation-The child care center shall operate in accordance with the terms specified in the plan of operation.
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Director will ensure that all unusual incidents are reported to the authorized representative in writing. The plan to ensure that all staff are following the Plan of Operation and issusing written incident reports will be submitted to CCL.
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This requirement has not been met as evidenced by: Child #1's authorizied representative was not provided an incident report following an unusual incident, per the Plan of Operation. This poses a possible risk to 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.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 09-CC-20200107164912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: SAN BERNARDINO CITY SCHOOL DIST.-ALLDRED CHILD DE
FACILITY NUMBER: 360906560
VISIT DATE: 01/29/2020
NARRATIVE
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It was reported that Child #1 may have had an injury that required medical attention and that medical attention was sought regarding the injury. However, LPA requested documentation and it was not provided during the course of this investigation. Therefore, LPA was not able to corroborate the allegation

Based on interviews, a review of pertinent documentation, and conflicting information received, the allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred.

An exit interview was conducted with the Director and a copy of this report and Appeal Rights were provided.

Notice of Site visit issued and posted during this visit.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Taadhimeka ZeiglerTELEPHONE: (951) 680-6745
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 5