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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494574
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:58:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
07/06/2022 and conducted by Evaluator Dalicia Adkins
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220706113843
FACILITY NAME:DEVONSHIRE PRESCHOOLFACILITY NUMBER:
197494574
ADMINISTRATOR:JACQUELINE SORIA LOPEZFACILITY TYPE:
850
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:60CENSUS: 24DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director Jacqueline Soria TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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9
 Neglect/Lack of Supervision- Staff did not adequately supervise children in care
INVESTIGATION FINDINGS:
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On 9/28/2022 at 11:00am Licensing Program Analyst (LPA) Dalicia Adkins arrived at the facility and was met by Director, Jacqueline Lopez. LPA Adkins informed Director about the purpose of the visit and was granted entry onto the facility. Director guided LPA Adkins on a tour of the facility. There were twenty-four children and four teachers present.

On 7/13/2022 LPA Adkins conducted 10-day complaint visit. During this visit LPA Adkins interviewed director and teachers. LPA conducted observations and collected the following supportive documents: children’s roster, teacher's roster, sign in and out print outs.

During today’s visit 9/28/22 LPA Adkins interviewed director, conducted facility observations and took pictures of the facility. LPA collected and reviewed a copy of parent agreement (2021-2023) and copy of parent announcement.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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 2
Control Number 30-CC-20220706113843
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: DEVONSHIRE PRESCHOOL
FACILITY NUMBER: 197494574
VISIT DATE: 09/28/2022
NARRATIVE
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Based on interviews, observations and record reviews no evidence has shown that there was a lack of care and supervision. 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 of lack neglect/lack of Supervision- staff did not adequately supervise children in care is unsubstantiated

No deficiencies cited during today visit 9/28/2022. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted, this report reviewed with director and copy given.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2