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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403941
Report Date: 07/22/2022
Date Signed: 07/25/2022 10:05:08 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2022 and conducted by Evaluator Lillian J Casillas
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220720153458
FACILITY NAME:POLAND FAMILY DAY CAREFACILITY NUMBER:
197403941
ADMINISTRATOR:POLAND, VICTORIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 841-8467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 5DATE:
07/22/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Victoria PolandTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Personal Rights: Staff used inappropriate discipline for child in care
Personal Rights: Staff used highchair as a restraint device for child in care
INVESTIGATION FINDINGS:
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On 7/22/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced complaint visit for the purpose of initiating the investigation regarding the allegations above. LPA met with Licensee, Victoria Poland. LPA observed 5 children in care. Staff 1 (S1) arrived at approximately 10:30AM.

During today’s investigation, LPA toured the inside and outside of the facility, and LPA interviewed Licensee and S1. S1 stated she put Child 1 (C1) in a highchair in the kitchen because he was not listening to her, then S1 went outside to the backyard with the rest of the children. Per the Licensee, the Licensee was not present during the incident.

Based on interviews with relevant parties, there is a preponderance of evidence to prove the alleged violations did occur. Therefore, the allegation is SUBSTANTIATED. A Type A deficiency was cited during today's inspection (see LIC 9099-D for details).
[CONTINUE ON PAGE 2]
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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 30-CC-20220720153458
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: POLAND FAMILY DAY CARE
FACILITY NUMBER: 197403941
VISIT DATE: 07/22/2022
NARRATIVE
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PAGE 2

Upon receipt of this report, the Licensee shall post the LIC 9213 Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 of Receipt (LIC 9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports.

An exit interview was conducted. A copy of this report was provided to Licensee, Victoria Poland, along with Appeal Rights and LIC 9213 Notice of Site Visit.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 30-CC-20220720153458
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: POLAND FAMILY DAY CARE
FACILITY NUMBER: 197403941
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2022
Section Cited
CCR
102423(a)(4)
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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. (4) To be free from...unusual punishment...
This requirement was not met as evidenced by:
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Licensee and S1 agree to: 1) retake the Family Child Care Home orientation and submit the certificate of completion by 8/22/2022; 2) watch Children's Personal Rights in Child Care video https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/ 4) watch Supervising
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Based on interviews, Staff 1 (S1) put Child 1 in a high chair in the kitchen because he was misbehaving, while she supervised the rest of the children in the backyard, which poses an immediate, health, safety, or personal rights risk to children in care.
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Children in Family Child Care video https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in--family-child-care 5) Create a calm space in the family child care home to help children self-regulate and submit photo of calm space to LPA by 8/1/2022.
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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: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3