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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494715
Report Date: 05/28/2021
Date Signed: 06/21/2021 12:12:49 PM

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
03/26/2021 and conducted by Evaluator Dalicia Adkins
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210326161022
FACILITY NAME:ABC SCHOOL HOUSEFACILITY NUMBER:
197494715
ADMINISTRATOR:BERNET-LEGUM, SUZANNEFACILITY TYPE:
850
ADDRESS:4102 W. VICTORY BLVDTELEPHONE:
(818) 842-8466
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:58CENSUS: 31DATE:
05/28/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Director Suzi LegumTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Daycare child was found outside the daycare with no supervision.
INVESTIGATION FINDINGS:
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On 5/28/2021 at 12:50pm Licensing Program Analyst (LPA) Dalicia Adkins conducted an unannounced tele-visit to deliver complaint findings. LPA met with Director Suzi Legum, who provided LPA with a virtual tour of the facility. There were 31 children, 4 teachers supervising and 1 teacher on break during today's visit.

Based on a video showing the child at the facility gate, additional information obtained, interviews conducted and admission from the Director, C1 wandered outside of the facility without any supervision for approximately 3-5 minutes. Therefore, the allegation of Lack of Supervision is substantiated. Meaning the allegation is valid because the preponderance of the evidence standard has been met.

P.1
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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 4
Control Number 30-CC-20210326161022
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: ABC SCHOOL HOUSE
FACILITY NUMBER: 197494715
VISIT DATE: 05/28/2021
NARRATIVE
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In accordance with California Code of Regulations, Title 22 Child Care Regulation this facility is being cited a Type A deficiency due to this posing an immediate Health and Safety risk to children in care. A violation regarding absence of supervision is an immediate $500 fine. Refer to LIC 421IM.

Upon receipt of this report, the licensee shall post the 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 enrolled children for the next 12 months (1 year). The acknowledgment 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 Acknowledgement of Receipt of Licensing Reports (LIC 9224).

Exit interview conducted, copy of LIC 9099, LIC 9099D, LIC9099A, LIC412M (Civil Penalty) LIC9224 Acknowledgement of Receipt of Licensing Reports, Notice of Site Visit and Appeal Rights issued via email with read receipt notification. If License is unable to sign and scan, a reply to this email acknowledging receiving licensing reports may be used in lieu of signature.

P.2

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 30-CC-20210326161022
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: ABC SCHOOL HOUSE
FACILITY NUMBER: 197494715
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/28/2021
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher... This requirement is not met as evidence by:
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Licensee agreed to conduct training on supervision and watch video on CCLD website regarding supervising children in child care. Licensee will send copy of signed roster to LPA by June 3, 2021 .
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C1 wandered outside of the facility main security gate for approximately three to five minutes, which poses an immediate health and safety risk to child(ren) in care.
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Type A
05/28/2021
Section Cited
HSC
1568.0822(c)(3)
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1568.0822 (c)(3): Health & Safety Civil Penalties: Absence of Supervision as required by statute and Regulation. Licensee is being cited an immediate $500.00 civil penalty for absence of supervision
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The licensee was informed all penalties are due and payable upon receipt of notice of payment and shall be paid only by check or money order made payable to the agency indicated in the notice.
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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: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
03/26/2021 and conducted by Evaluator Dalicia Adkins
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210326161022

FACILITY NAME:ABC SCHOOL HOUSEFACILITY NUMBER:
197494715
ADMINISTRATOR:BERNET-LEGUM, SUZANNEFACILITY TYPE:
850
ADDRESS:4102 W. VICTORY BLVDTELEPHONE:
(818) 842-8466
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:58CENSUS: 31DATE:
05/28/2021
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Director Suzi LegumTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Day care child's diapering needs were not met.
INVESTIGATION FINDINGS:
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On 5/28/2021 at 12:50pm Licensing Program Analyst (LPA) Dalicia Adkins conducted an unannounced complaint tele-visit to conclude a complaint investigation. LPA met with Director Suzi Legum, who guided LPA on a tour of the facility. There were 31 children and 5 teachers present during today's visit. On 3/30321 LPA Adkins conducted the 10- day complaint visit. LPA interviewed Director and the following records requested: sign in/out sheets, supervision policy, daily schedule, teacher roster, updated personnel and children roster. During this investigation staff and parent were interviewed.
Based on observations, record reviews, it was determined that the above allegation(s) to be UNSUBSTANTIATED, meaning that the allegation evidence was insufficient to satisfy the preponderance of the evidence standard. Exit interview conducted and copy of this report provided to License via email. If License is unable to sign and scan, a reply to this email acknowledging receiving licensing reports may be used in lieu of signature.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4