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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198011349
Report Date: 11/12/2021
Date Signed: 11/12/2021 12:58:51 PM

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 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
10/25/2021 and conducted by Evaluator Judy Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211025140916
FACILITY NAME:CDCLA - TINY DOTS EARLY EDUCATION CENTERFACILITY NUMBER:
198011349
ADMINISTRATOR:MICHELLE JOHNSONFACILITY TYPE:
850
ADDRESS:100 S. MAIN STREETTELEPHONE:
(213) 897-0049
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY:60CENSUS: 34DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Michelle Johnson TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff did not change child's diaper.
Staff did not give the day-care child water.
Day-care child had an unexplained injury.
Facility disrespected child when snatching something out of child's hand.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced site inspection on this date to conclude the investigation for the above complaint allegations. LPA met with Director Michelle Johnson.

During the course of this investigation LPA visually observed the preschool and toddler components both indoors and outdoors. Interviews were conducted with staff from both the toddler and preschool components. LPA obtained copies of staff and children's time sheets for the week of 08/16/21 through 08/20/21.

Although the allegations may have happened or are valid there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.
Exit interview was conducted with Director, Michelle Johnson. Appeal rights provided.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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
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
10/25/2021 and conducted by Evaluator Judy Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211025140916

FACILITY NAME:CDCLA - TINY DOTS EARLY EDUCATION CENTERFACILITY NUMBER:
198011349
ADMINISTRATOR:MICHELLE JOHNSONFACILITY TYPE:
850
ADDRESS:100 S. MAIN STREETTELEPHONE:
(213) 897-0049
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY:60CENSUS: 34DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Michelle Johnson TIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Facility out of ratio.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced site inspection on this date to conclude the investigation for the above complaint allegation. LPA met with Director Michelle Johnson.

During the course of this investigation LPA visually observed the preschool and toddler components both indoors and outdoors. Interviews were conducted with staff from both the toddler and preschool components. LPA obtained copies of staff and children's time sheets for the week of 08/16/21 through 08/20/21.

During the review of both staff and children time sheets, it was found that on 08/19/21 there were 8 toddlers with 01 staff before 08:39 AM, placing the facility out of ratio. Based on the available information, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations,(Title 22, Division 12 & Chapter Number 1), are being cited on the attached LIC. 9099D.

*REPORT CONTINUES ON NEXT PAGE

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20211025140916
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: CDCLA - TINY DOTS EARLY EDUCATION CENTER
FACILITY NUMBER: 198011349
VISIT DATE: 11/12/2021
NARRATIVE
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This was a potential risk to the Health and Safety risk to clients in care.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation or substantiated complaint. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted with Director, Michelle Johnson. Appeal rights provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20211025140916
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: CDCLA - TINY DOTS EARLY EDUCATION CENTER
FACILITY NUMBER: 198011349
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
1596.955(a)(3)
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Child day care centers serving preschool age children; optional program; departmental guidelines and regulations
A ratio of six children to each teacher is maintained for all children in attendance at the toddler program. An aide who is participating in on-the-job training may be
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This citation was previously cited on 09/13/21 for being out of ratio on 08/05/21. The facility already addressed the ratio issue and is still in the process of correction. Director will submit a new LIC 500 to show new staff and hour changes. Civil penalty will not be assessed on this instance for the same reasoning mentioned above.
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substituted for a teacher when directly supervised by a fully qualified teacher.
This requirement was not met as evidenced by facility file review. Sign in and out sheets show that on 08/19/21, there were 8 toddlers present with 01 staff before 8:39 AM. This posed a potential Health and Safety risk to clients 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.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4