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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870577
Report Date: 10/04/2023
Date Signed: 10/04/2023 02:05:38 PM

Document Has Been Signed on 10/04/2023 02:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLOWBROOK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191870577
ADMINISTRATOR:SONIA LOVEFACILITY TYPE:
850
ADDRESS:12829 SO. JARVIS AVE.TELEPHONE:
(310) 352-4486
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 39DATE:
10/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Acting site supervisor, Chenieka Morgan-MillsTIME COMPLETED:
02:20 PM
NARRATIVE
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On October 4, 2023 at 10:30 am, Licensing Program Analysts (LPAs) Angelica Wallin and Jeanette Estrada conducted a Case Management Incident inspection. This inspection is regarding a personal rights incident that took place on September 21, 2023 in which a substitute teacher made statement about a child in front of other children that was inappropriate. LPA met with Acting site supervisor, Chenieka Morgan-Mills who provided information and assistance during the inspection. A census of 39 children was taken.

During the course of the inspection, LPAs conducted interviews with three children and two staff. LPAs also reviewed the following documents: a September 21, 2023 unusual incident report, ratio sheet on day of incident, employee background clearance, employee HR reports, and employee witness written declaration statement. During staff interviews, it was discovered that staff did not address teacher’s statement with children. Per teacher, she addressed statement made with substitute directly and informed her it was inappropriate. Although it was addressed to teacher, it was not addressed to children present . LPAs provided education to acting site supervisor regarding Title 22 section 101223 (a)(1) concerning personal rights. Type B citation issued.

During record review of 9/21/23 unusual incident report, LPAs observed that no telephone or fax report to the department within 24 hours of the incident was conducted. Staff only reported the incident on 9/27/2023 (seven days after incident) via emailed written report to LPA A. Wallin (assigned analyst). LPAs provided education to acting site supervisor regarding Title 22 section 101212 (d)(1)(C) regulations concerning reporting requirements. Type B citation issued.

Based on the available information: interviews with staff and children and record review, today’s finding is result of Title 22 violations, see LIC809D. The content of this report was read and discussed in detail at the time of inspection with acting site supervisor, Chenieka Morgan-Mills. An exit interview was conducted, and a copy of appeal rights was provided.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/04/2023 02:05 PM - It Cannot Be Edited


Created By: Angelica Wallin On 10/04/2023 at 01:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLOWBROOK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
101223(a)(1)

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101223 (a) The licensee shall ensure that each child is accorded the following personal rights:
(1)To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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Facility to conduct trainings via CCLD educational videos on the following topics: children's personal rights in childcare and supervising children in child care centers and submit completed log of trainings via email.
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Based on staff interviews, the licensee did not comply with the section cited above in: staff not addressing teacher’s statement with children present which poses/posed a personal rights risk to persons in care.
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Type B
10/13/2023
Section Cited
101212(d)(1)(C)

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101212 (d) a report shall be made to the Department by telephone or fax within the Department's next working day...(1) Events reported shall include the following (C)Any unusual incident...that threatens the...emotional health or safety of any child.
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Facility to conduct trainings via CCLD educational videos on the following topics: child care reporting requirements for child care center operators and submit completed log of trainings via email.
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This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in: that no telephone or fax report was made to the department within 24 hours of the incident which poses/posed a personal rights risk to persons 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:Karen Chambers
LICENSING EVALUATOR NAME:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023


LIC809 (FAS) - (06/04)
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