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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419346
Report Date: 01/18/2023
Date Signed: 01/18/2023 02:38:03 PM

Document Has Been Signed on 01/18/2023 02:38 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHILDREN'S COLLECTIVE - HOPE MEMORIALFACILITY NUMBER:
197419346
ADMINISTRATOR:BACH, ROCIOFACILITY TYPE:
850
ADDRESS:3401 SOUTH SOMERSET DRIVETELEPHONE:
(310) 733-4388
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
01/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Hr Manager Yolanda Walters and Program Manager Erynn LaurentTIME COMPLETED:
01:30 PM
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On January18, 2023 at 1:09 PM, an unannounced Case Management visit was conducted by Regional Manager (RM) Victor Bautista and Licensing Program Analyst (LPA) Antonio Almanza for the purpose of providing findings for the investigation completed by the Department of Social Services of allegations of suspected child abuse. RM and LPA met with HR Manager Yolanda Walters and Program Manager Erynn Laurent at the facility headquarters, located in Los Angeles Ca 90045.

The Department of Social Services received a self-reported Unusual Incident, reported by Staff 1 to CCLD and crossreported to DCFS/CPS through a Suspected Child Abuse Report (SCAR) on 11/22/22. S1 reported that Staff 2 (S2) witnessed alleged abuse such as children mentally, emotionally, verbally, and physically by hitting, pushing, and pinching.

IB Investigator Miles conducted interviews regarding the aforementioned allegation. The investigator interviewed Child 1 (C1), Staff 2, Staff 3, and Staff 4 (S2, S3 and S4). C1 was unable to explain and articulate the incidents of abuse caused by S2. Interviews conducted on 01/05/2023, revealed that S3 and S4 witnessed S2 push, grab, dragg, and pull the hair of C1. Interview conducted on 01/05/2023, by Investigator Miles, revealed that S2 admitted to pushing, pulling, and grabbing C1. S2 denied pulling C1s hair.

Based on observations, interviews, record review(s), and statements of admission provided by S2, the preponderance of evidence standard has been met.

One Type A deficiency is being issued under Health and Safety Code, Title 22, Division 6 and Chapter 3.4, section 1596.8897 Prohibited positions or employment; grounds; notice; removal; appeal; petition for reinstatement, (a)(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHILDREN'S COLLECTIVE - HOPE MEMORIAL
FACILITY NUMBER: 197419346
VISIT DATE: 01/18/2023
NARRATIVE
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One Type A deficiency is being issued under California code of Regulations, Title 22, Division 12 and Chapter 1, section 101223 Personal Rights, (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

Staff 2 was placed on Suspension for a period of 2 weeks pending Investigation and ultimately resigned on 01/06/2023.

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Failure to maintain posting as required will result in a $100.00 civil penalty.

**In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months. The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

A copy of this Report, Notice of Site Visit, and Appeal Rights were explained and provided to HR Manager Yolanda Walters and Program Manager Erynn Laurent.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/18/2023 02:38 PM - It Cannot Be Edited


Created By: Antonio Almanza On 01/18/2023 at 01:20 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN'S COLLECTIVE - HOPE MEMORIAL
FACILITY NUMBER: 197419346

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/20/2023
Section Cited
HSC
1596.8897(a)(2)

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1596.8897 Prohibited positions or employment; grounds; notice; removal; appeal; petition for reinstatement, (a)(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility...
This Requirement is not met as evidenced by:
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Lcensee is reporting that Staff 2 resigned on 01/06/23 and is no longer employed. Licensee agrees to provide LPA with staff rsoter of staff that attended the
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Based on observation, interview and record review, Investigations revealed that S2 admitted to pushing, pulling, and grabbing C1, which poses an immediate or Health and Safety, and personal rights risk to persons in care.
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Quartely Training that was provided in December 16, 2023 on madated reporting.
Type A
01/20/2023
Section Cited
CCR101223(a)(3)

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101223 Personal Rights, (a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to...
This Requirement is not met as evidenced by:
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Lcensee is reporting that Staff 2 resigned on 01/06/23 and is no longer employed. Licensee agrees to include personal rights training during the inservice training that will be conducted in March
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Based on observation, interview and record review, Investigations revealed that S2 admitted to pushing, pulling, and grabbing C1, which poses an immediate or Health and Safety, and personal rights risk to persons in care.
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and a schedule will be provided to LPA.
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:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023


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