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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198010536
Report Date: 09/13/2024
Date Signed: 09/13/2024 01:31:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
07/16/2024 and conducted by Evaluator Ashley Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20240716124813
FACILITY NAME:TILLMAN FAMILY CHILD CAREFACILITY NUMBER:
198010536
ADMINISTRATOR:TILLMAN, TRACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 209-8686
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:14CENSUS: 3DATE:
09/13/2024
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Staff / Adriane Carrington TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee hit daycare child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Calderon arrived at the above licensed facility for the purpose of conducting investigation for the above complaint allegation. LPA met with staff Adriane Carrington who granted LPA entrance to the facility.

Per staff Ms. Carrington, Licensee is currently at a doctor's appointment. LPA spoke with Licensee Tracey Tillman and staff and explained purpose of today's visit. Via telephonically LPA consulted with Licensee stated temporary absence may not exceed 20% of the facility operation hours.

During today's visit, LPA attempted to conduct children interviews and per staff Ms. Carrington gave LPA Calderon permission to conduct a self guided tour. 1 Staff was present at the facility with 3 children (1 included an infant), LPA conducted a self guided tour. (Page 1 / Continuation...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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 54-CC-20240716124813
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536
VISIT DATE: 09/13/2024
NARRATIVE
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Per interview with Licensee Tracy Tillman informed LPA Calderon due to inappropriate incident/ inappropriate behaviors by two children in care, licensee used their open hand to slap Child #1 on their hand, Licensee stated parent gave verbal consent. Therefore, it was determined that Inappropriate discipline was used.

The following deficiencies listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S. Type A given. LPA explained to Ms. Tillman what is needed due to the deficiency given today via telephonically.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview was conducted and report was reviewed and provided to Staff Adriane Carrington.

(Page 2/ End of Report)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 54-CC-20240716124813
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2024
Section Cited
CCR
102423(a)(4)
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Personal Rights(a) Ea. child receiving services from a FCC...shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include...the following:
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LPA Calderon provided Licensee Tillman Regulation on Personal Rights to review and website link from CCLD Resource for parents and providers video regarding Child Care Personal Rights via telephonically. Licensee will review and sign a declation statement on LIC855 by POC due date: 9/16/24.
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(4) To be free... corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other...punitive nature, including...interference w/ eating, sleeping or toileting...or aids to physical functioning.The requirement was not met as evidanced by: Licensee interview with LPA Calderon stated I popped Child #1 with my open hand on their hand, per parent consent (verbal).
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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: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4