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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198001351
Report Date: 08/10/2023
Date Signed: 08/10/2023 11:19:52 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/12/2023 and conducted by Evaluator Warren Birks
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20230712160352
FACILITY NAME:92ND & MAIE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198001351
ADMINISTRATOR:ALICIA GARCIAFACILITY TYPE:
850
ADDRESS:9200 MAIE AVE.TELEPHONE:
(323) 249-0621
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY:54CENSUS: 33DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Marissa DominguezTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff hit daycare child
Staff handled daycare child in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced complaint inspection to investigate the above allegations. LPA met with Site Supervisor Marissa Dominguez who provided assistance during the investigation.

During the course of the investigation, LPA conducted interviews with five children (in the same class as child #1), four staff who (interact with child #1) and non-staff adults connected to the facility. LPA also reviewed a May 8, 2023 incident report and a photo of child #1. In addition, LPA referred to a May 10th, 2023 Licensing inspection (in which two LPAs indcated they received no disclosure from staff and child #1). LPA Birks also received no disclosure from children and staff that they witnessed anything related to these allegations.

LPA also received corroboration information from staff that the facility utilizes communicating and redirection when working with children. LPA received no other information that would help substantiate or make the allegations unfounded. CONTINUED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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 54-CC-20230712160352
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: 92ND & MAIE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198001351
VISIT DATE: 08/10/2023
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, at this time the allegation is Unsubstantiated.

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 with Site Supervisor Marissa Dominguez.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2