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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 493007243
Report Date: 04/20/2020
Date Signed: 04/20/2020 10:54:25 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2020 and conducted by Evaluator Jennifer Velasco
COMPLAINT CONTROL NUMBER: 01-CC-20200224112229
FACILITY NAME:LITTLE ANGELS CHILDREN'S CENTERFACILITY NUMBER:
493007243
ADMINISTRATOR:TAMBLIN, KRISTINFACILITY TYPE:
850
ADDRESS:4305 HOEN AVENUETELEPHONE:
(707) 579-4305
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:36CENSUS: 0DATE:
04/20/2020
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kristin TamblinTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Lack of supervision resulting in child being bitten by another child.
INVESTIGATION FINDINGS:
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Due to COVID-19 an announced tele-visit was conducted by Licensing Program Analyst (LPA) Jennifer Velasco to deliver complaint investigation findings to the facility director (D1). It has been alleged that staff failed to provide supervision, resulting in a child (C1) being bitten by another child (C2) while in care. On 02/28/2020, LPA interviewed director (D1) at 1:00 p.m. D1 denied the allegation and stated that while C2 did bite C1, it was not due to a lack of supervision. D1 stated staff provided immediate care to C1 and reported the incident as required. LPA requested and received copies of facility records. LPA observed 17 children in care supervised by three staff. LPA interviewed three staff (S1-S3) and reviewed records. LPA attempted to qualify several children but was unable to do so. LPA conducted additional interview with one adult (A1) on 03/06/2020 and received relevant documents on 03/06/2020. During today’s inspection, the facility was closed due to Covid-19 pandemic and ensuing shelter in place orders. Interviews and document reviews corroborate the allegation that lack of supervision resulted in C1 being bitten by C2. An exit interview was conducted. Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. This report was reviewed and discussed with the facility director.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020
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 3
Control Number 01-CC-20200224112229
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LITTLE ANGELS CHILDREN'S CENTER
FACILITY NUMBER: 493007243
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2020
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. 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 was not met as evidenced by:
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Director (D1) stated staff retraining will focus on visual supervision of all chidlren at all times. D1 stated she will document the time, date, and method of training in detail and will obtain staff signatures. D1 stated she will provide this documentation to LPA on or before 05/15/2020 via email.
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LPA's document reviews and interviews which corroborated that a child (C1) was bitten multiple times by another child (C2), sustaining injuries needing medical care, which staff did not witness. This constitutes a potential risk to the health and safety of children in care.
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LPA's email:
jennifer.velasco@dss.ca.gov
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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 01-CC-20200224112229
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: LITTLE ANGELS CHILDREN'S CENTER
FACILITY NUMBER: 493007243
VISIT DATE: 04/20/2020
NARRATIVE
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 L1's original signature was not recorded on this report; however, L1 was provided with a copy of the LIC 9099 Complaint Investigation Report (CIR), and L1’s confirmation of L1's receipt of this CIR is on file.

The following violation(s) of the California Code of Regulations, Title 22 were cited: See LIC 9099-D. Appeal Rights were provided.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3