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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191570863
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:10:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 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
04/30/2024 and conducted by Evaluator Stephanie Li
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20240430145302
FACILITY NAME:L.A. COUNTY FAIR ASSOC. CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191570863
ADMINISTRATOR:ALEXIS GORDILLOFACILITY TYPE:
850
ADDRESS:1101 W. MCKINLEY, GATE ATELEPHONE:
(909) 623-3899
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:161CENSUS: 114DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Site Supervisor Salina AvalosTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff grabbed daycare child resulting in injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced site inspection to present the findings of the above complaint allegations. Licensing staff met with Site Supervisor Salina Avalos to whom the reason for the visit was explained. Director provided a tour of the facility. Present during the inspection was 24 teachers and 114 children.

Allegation: Staff grabbed daycare child resulting in injury.

During the investigation Licensing staff conducted interviews with supervisor, facility staff, and daycare child. Licensing staff also obtained several documents related to the complaint allegation, including but not limited to, a copy of the Facility Roster, Incident and Ouch reports from facility, photos, parent teacher conference notes, parent handbook, and employee handbook. Childrens files were also reviewed during this investigation.
Continued on next page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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
Control Number 33-CC-20240430145302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: L.A. COUNTY FAIR ASSOC. CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191570863
VISIT DATE: 06/18/2024
NARRATIVE
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Based on statements obtained from all staff and child’s interviews and record review. Interviews with staff and children revealed that child wears wrist watch on both wrist tightly along with wrist bands on each wrist. There were no disclosures to corroborate the allegation or evidence to support the allegation. Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was reviewed and appeal rights provided with Site Supervisor Salina Avalos.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 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
04/30/2024 and conducted by Evaluator Stephanie Li
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20240430145302

FACILITY NAME:L.A. COUNTY FAIR ASSOC. CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191570863
ADMINISTRATOR:ALEXIS GORDILLOFACILITY TYPE:
850
ADDRESS:1101 W. MCKINLEY, GATE ATELEPHONE:
(909) 623-3899
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:140CENSUS: 114DATE:
06/18/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Site Supervisor Salina AvalosTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not notify parent of child's injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced site inspection to present the findings of the above complaint allegations. Licensing staff met with site supervisor Salina Avalos to whom the reason for the visit was explained. Site Supervisor provided a tour of the facility. Present during the inspection was 24 teachers and 114 children.

Allegation: Staff did not notify parent of child's injury.

During the investigation Licensing staff conducted interviews with supervisor, facility staff, and daycare child. Licensing staff also obtained several documents related to the complaint allegation, including but not limited to, a copy of the Facility Roster, Incident and Ouch reports from facility, parent handbook, and employee handbook. Child’s files were also reviewed during this investigation.

Continued on next page....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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 33-CC-20240430145302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: L.A. COUNTY FAIR ASSOC. CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191570863
VISIT DATE: 06/18/2024
NARRATIVE
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Based on statements obtained from all staff interviewed and record review, disclosures were made from staff regarding staff not notifying parent of child’s injury corroborating the allegation, therefore, the above allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22 are being cited on the attached LIC9099D.

At this time, a Type-A deficiency is being cited. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

One (1) Type A - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given to licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview was reviewed and appeal rights provided with Site Supervisor Salina Avalos.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 33-CC-20240430145302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: L.A. COUNTY FAIR ASSOC. CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191570863
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2024
Section Cited
CCR
101226.3(b)
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Observation of the child...(b) Any unusual behavior, any injury...illness requiring assessment...administration of first aid...shall be reported to the child's authorized representative and recorded in the child's record.
This requirement is not met evidenced by:
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Per site supervisor, she has created documentation forms and will hand out to all teachers classrooms for proper documentation by end of today for immediate use. Site Supivsor will implement injury/ouch reporting training and documenting in
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Based on interview and records review, child sustained injury on wrist and reported to teachers, all staff notified did not document or notify guardian of injury, which poses a health and safety risk to children in care.
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next staff meeting. She will provide meeting agenda, training forms, and meeting staff sign via email to LPA by 6/28/24.
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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: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5