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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197416658
Report Date: 10/06/2022
Date Signed: 10/06/2022 09:33:32 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
07/21/2022 and conducted by Evaluator Denise Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220721122029
FACILITY NAME:BAREFOOT PRESCHOOLFACILITY NUMBER:
197416658
ADMINISTRATOR:AVITAL, KARENFACILITY TYPE:
850
ADDRESS:1620 S. BUNDY DRIVETELEPHONE:
(424) 293-2197
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY:20CENSUS: 9DATE:
10/06/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karen Avital, Director TIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Personal Rights - Daycare child sustained injury while in care.
INVESTIGATION FINDINGS:
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On 10/06/2022 Licensing Program Analyst (LPA) Denise Miranda and Licensing Program Manager (LPM) Claudia Escobedo conducted an unannounced visit for the purpose of delivering findings for the above listed allegation. LPA Miranda and LPM Escobedo arrived at 8:30AM and met with Karen Avital, Director, who guided LPA Miranda and LPM Escobedo on a tour of the facility. There were 09 children with 01 staff and Director upon arrival. Around 9am the second arrived at the facility.
During the investigation LPA Miranda interviewed staff, children, and parent. LPA obtained a copy of the children's roster, sign-in/sign-out form for the date of 06/29/2022, parent handbook, copy of the contract agreement between parent #1 and facility, supporting documentation, pictures of the outdoor play space and video footage from 06/29/2022 that was provided by Director Avital.
On 07/20/2022, facility Director Avital contacted LPA Miranda and reported over the
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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 5
Control Number 30-CC-20220721122029
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: BAREFOOT PRESCHOOL
FACILITY NUMBER: 197416658
VISIT DATE: 10/06/2022
NARRATIVE
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phone an unusual incident that occurred on 06/29/2022. Per Director, on 06/29/2022, a staff contacted the paramedics to attend to Child #1, who was present at the facility. Director Avital stated that she was not present when this incident happened. Director Avital also stated that she reported this incident to the El Segundo Regional Office – Community Care Licensing by recommendation of her insurance broker.

On 08/03/2022, LPA Miranda obtained a copy of a five-minute video dated on 06/29/022 with a start time of 3:52 p.m.

On 09/08/2022, LPM Escobedo and LPA Miranda met with Director Avital via Microsoft Teams so that Director Avital could share additional video footage from the day of 06/29/2022, with a time starting at 3:30 p.m. and ending at 3:39 p.m. On 09/19/2022, LPM Escobedo sent an email to Director Avital requesting that Director provide footage from 06/29/2022 during the hours of 3:39 p.m. to 3:52 p.m. Until today, Director Avital has not provided a copy of the video footage from the day 06/29/2022, during the time of 3:39 p.m. to 3:52 p.m.

Information provided by the reporting party indicates that Child #1 sustained injury, on 06/29/2022 while in care at Barefoot Preschool.

During the investigation, LPA Miranda interviewed children, who disclosed that an incident happened involving Child #1 and Child #3. Additionally, Staff#1 disclosed that on 06/29/2022, children were playing in the outdoor area by the slide and Child #3 stated that he hit Child #1 on the forehead with his foot, while Child#3 was coming down from the top of the slide and Child #1 was sitting at the bottom of the slide. Child #1 and Child #2 confirmed this incident as well to LPA. In addition, LPA and LPM observed that on the video footage provided by Director, Child#1, while sitting on the bottom of the slide, multiple children were coming down and bumping Child #1’s back.

Based on LPA observation of video footage, interviews, record review and supporting documentation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 Article 06. Continuing Requirements – 101223 1(a), is being cited on the attached deficiencies page.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 30-CC-20220721122029
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: BAREFOOT PRESCHOOL
FACILITY NUMBER: 197416658
VISIT DATE: 10/06/2022
NARRATIVE
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LPA explained that the deficiency was a Type A violation and required immediate correction. Licensee was further informed of AB633 requirements. Licensee was provided a copy of the LIC9224 – Acknowledgement of Receipt of Licensing Reports and instructed to provide copies of this report to all parents of children currently enrolled and to obtain the parent's signature on form LIC9224, as acknowledgement that they received a copy of this report. Form LIC9224 is to be retained in the child's file. Licensee was further instructed to complete this same process for all children who enroll in the facility within 12 months of this report date.

Licensee was instructed to post this report, along with the Notice of Site Visit, at the main entrance of the facility for 30 days. Failure to comply with the above posting requirements may result in a civil penalty.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and Plans of Correction were reviewed and developed with Karen Avital. A copy of the report and appeal rights were discussed and left with the Licensee, Karen Avital, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 30-CC-20220721122029
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: BAREFOOT PRESCHOOL
FACILITY NUMBER: 197416658
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2022
Section Cited
CCR
101223(a)(1)
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101223(a) (1) Personal Rights: (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.


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Director agreed to conduct training with all staff regarding personal rights, safety, care and supervision and reporting requirements.
Director will provide a copy of the
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This requirement is not met as evidenced by: Based on LPA observation of record review, video footage, interviews children, who disclosed that an incident happened where Child#3 hit Child#1 on the forehead with his foot, while was in care on 06/29/2022, which affect the physical well-being of the child#1. Which poses immediate Health, Safety or Personal Rights risks to children in care.
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training agenda along with the Staff attendee signature via email no later than 10/17/2022. Additionally, Director will submit to LPA via email copies of the form LiC9224 Acknowledgment of Receipt of Licensing Reports sign by parent for all children enrolled no later than 10/12/2022.

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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.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5