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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191204631
Report Date: 11/14/2023
Date Signed: 11/14/2023 12:49:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2023 and conducted by Evaluator Anomeh Eivazian
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20231113091418
FACILITY NAME:SUSANNA WESLEY CHILDREN'S CENTERFACILITY NUMBER:
191204631
ADMINISTRATOR:MORENA DURANFACILITY TYPE:
850
ADDRESS:134 N. KENWOOD ST.TELEPHONE:
(818) 548-6229
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:36CENSUS: 14DATE:
11/14/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Morena Duran, DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are commingling day care children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced complaint inspection in regards to the above allegation. LPA arrived at 11:10 a.m. on 11/14/23 and met with Morena Duran, director who guided analyst on a tour of the facility. During this inspection there were 12 preschoolers present in the facility. There is an infant program in the facility address with facility number 191226432.

During this investigation, LPA Eivazian conducted an interview with staff#1. Also LPA obtained a copy of facility current roster, sign in /out sheet for Yellow Family classroom for 09/21/23 and 09/22/23, and a copy of child#1 Health History form, LIC 702.

Based on an interview that was conducted with staff#1, child#1 is under two years old and moved from Infant classroom to preschool Yellow Family classroom almost for about month ago, since 09/21/23. Per staff#1, child#1 was moved to Yellow Family classroom when child#1 was 22 months old (an infant). A written declaration obtained from director.
REPORT CONTINUES ON NEXT PAGE 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
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 33-CC-20231113091418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631
VISIT DATE: 11/14/2023
NARRATIVE
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Based on LPA's observations, on 11/14/23 upon LPA's arrival to the facility at 11:10AM, LPA observed 10 children were present in the preschool Yellow Family classroom (2-3 years old), and playing outside with 3 staff. Per staff#1 and staff#2, child#1 was present during this inspection and was playing outside with Yellow Family classroom children.

Based on LPA’s observations and interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated at this time. California Code of Regulations 101161 (a)--Limitations on Capacity-- (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation is cited during this inspection.

LPA Anomeh Eivazian informed director, Morena Duran that this report dated 11/14/23 documents 1 of Type A citation. Type A citations which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Anomeh Eivazian informed the director, Morena Duran to provide a copy of this licensing report dated 11/14/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the director, Morena Duran at 1:00 PM.


REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20231113091418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2023
Section Cited
CCR
101161(a)
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Limitations on Capacity-- (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement was not met as evidence by....
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Per director, effective 11/15/23, child#1 will go to infant classroom until turns two.

A written declaration was submitted to LPA during this inspection.
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Per staff#1, child#1 an infant, moved to Yellow Family preschool classroom (2-3 year old) since 09/21/23 when child#1 was 22 months old.
This poses an immediate health, safety and personal right risk to the 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: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3