566210209-2-7-2020-17-CC-GMIE-BLNTTK-20200210140048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 566210209
Report Date: 02/07/2020
Date Signed: 02/07/2020 10:47:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/16/2020 and conducted by Evaluator Betzayra Cervantes

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20200116125114

FACILITY NAME:	CDR - BERYLWOOD HEAD START CENTER		FACILITY NUMBER:	566210209
ADMINISTRATOR:	SUZANNE GODINEZ		FACILITY TYPE:	850
ADDRESS:	2300 HEYWOOD ST.		TELEPHONE:	(805) 583-3775
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	43	CENSUS: 36	DATE:	02/07/2020
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Jennie Will		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Personal Rights - Child Sustained Injury While in Care
Record Keeping - Center did not report to the parent 3 other injuries sustained by the child

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Betzayra Cervantes and Licensing Program Manager (LPM) Mingle conducted an unannounced inspection to conclude a complaint investigation. LPA met with facility Site Supervisor Jennie Will and advised her the purpose of the inspection. LPA and Director together toured the facility inside and out. There were 36 children in care by 7 staff teachers at the time of the inspection.

Complaint received alleged "Child Sustained Injury While in Care" and “Center did not report to the parent 3 other injuries sustained by the child.” Investigation included two unannounced visits, interviews with current and past parents, staff interviews, and the complainant. LPA reviewed children files and facility records during the initial inspection. On 12/11/19, the Center self-reported the incident which occurred on 12/02/2019, at or about 10:30 A.M., according to staff interviews, child (C1) ran into the ring of a dancing ribbon while twirling outside on the playground injuring her left eye.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

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 17-CC-20200116125114

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CDR - BERYLWOOD HEAD START CENTER	FACILITY NUMBER: 566210209
	VISIT DATE: 02/07/2020

NARRATIVE

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Based on staff interviews, there were two staff supervising 18 children at the time of the incident. Staff immediately provided comfort and an icepack to C1 and attempted to contact the parent. Facility and parent advised that C1 has a preexisting medical condition which increases the sensitivity in the eye area. Parent of C1 took the child to get medical treatment and the statements provided by the parent revealed that the physician was unable to determine if the resulting injury occurred as a result of the incident or if it was related to the medical condition. The facility is actively working with the child and parent to provide resources and identify solutions that promote the child’s success in the program.

Regarding the allegation that facility staff failed to notify appropriate parties of the incident, parent of C1 stated that she was verbally informed by staff of the prior incidents and facility records revealed that one of the incidents in question was documented. Staff advised when incidents happen, they are reported to parents either verbally, by telephone and/or written notice. Interview with the Site Supervisor revealed that the facility has procedures in place for when a child gets hurt. There was no incident report created for the two alleged incidents that occurred, but the parent was verbally informed given that the incidents did not result in an injury.

Parent interviews did not corroborate with the above allegations, but did corroborate with staff. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020

LIC9099 (FAS) - (06/04)

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