Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198006098
Report Date: 11/20/2018
Date Signed: 11/20/2018 02:32:11 PM


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2018 and conducted by Evaluator Raul Navarro
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20181008112549

FACILITY NAME:RANCHO LOS AMIGOS CHILDREN'S CENTERFACILITY NUMBER:
198006098
ADMINISTRATOR:ANA MARTINEZFACILITY TYPE:
850
ADDRESS:7755 GOLONDRINAS STREETTELEPHONE:
(562) 401-7981
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:59CENSUS: 30DATE:
11/20/2018
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ana MartinezTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Reporting requirements-incidents not reported to CCL
INVESTIGATION FINDINGS:
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LPA Navarro conducted an unannounce complaint inspection for the purpose of delivering the findings for the allegation above. LPA met with Director Ana Martinez who guided LPA on a tour of the faciilty. There were 30 children present during today's inspection.

During the course of the investigation, LPA Navarro conducted interviews with the Director and Preschool Staff. Per Director, they did not report the incident to the Department because although the child stayed outside during transition, there was a teacher in the play yard. Therefore, child was not left alone.

Based on LPA’s observations and the Director's own admittance, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, 101212(d)) are being cited on the attached LIC 9099-D.

*Report continues on the next page*
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 33-CC-20181008112549
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RANCHO LOS AMIGOS CHILDREN'S CENTER
FACILITY NUMBER: 198006098
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2018
Section Cited
CCR
101212(d)
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Reporting Requirements- A report shall be made to the Department within 24 hours of the occurrence of any unusual incident as specified. This requirement was not met as evidenced by file review. Director did not submit an unusual incident regarding a child staying outside in the play yard while rest of
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Per Director, she will submit an unusual incident to the department by the POC date of 11/27/18.
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the classroom was inside. This is a potential risk to the health and safety of the children in care.
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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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2018
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 33-CC-20181008112549
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RANCHO LOS AMIGOS CHILDREN'S CENTER
FACILITY NUMBER: 198006098
VISIT DATE: 11/20/2018
NARRATIVE
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Exit interview was conducted with the Director Ana Martinez. The Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

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

Report ends- Page 2 of 2
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2018
LIC9099 (FAS) - (06/04)
Page: 5 of 6