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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198015657
Report Date: 07/15/2024
Date Signed: 07/16/2024 07:59:20 AM

Substantiated


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
06/11/2024 and conducted by Evaluator Dayna Chambers
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20240611151030
FACILITY NAME:UNION PACIFIC CDC/YWCA OF GREATER L.A.FACILITY NUMBER:
198015657
ADMINISTRATOR:NORMA GONZALEZFACILITY TYPE:
850
ADDRESS:4315 UNION PACIFIC AVENUETELEPHONE:
(323) 415-6057
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:43CENSUS: 33DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Adriana.Velazco, DirectorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Child was injured while in care
INVESTIGATION FINDINGS:
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On July 15, 2024, at 9:30AM, Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced visit to deliver findings regarding the above complaint allegations. At 9:40AM, LPA toured facility with Norma Gonzalez, Site Supervisor. There were 18 children with 3 staff in the Little Stars Room and 13 children with 2 staff in the Care Bears Room during the inspection.
During this investigation, LPA interviewed Staff and parents, and collected documents. Documents collected: LIC9040 Roster, Parent Handbook, sign in/Sign Out for June 2024, Ouch/Incident Reports for June 2024.
Allegation: Child was injured while in care.
Based on Observation, Record Review, and confidential Interviews with Staff and parents, a child did bite another child during circle time, staff did observe the incident. The center followed the protocols by providing care to child, documenting the incident on incident/ouch reports, and notifying the parent of the incident. The injury did not require medical attention outside of the center. The staff communicated to both children and also the children’s parents about the incident. LPA concludes the incident was not a result of lack of supervision.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
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 5
Control Number 54-CC-20240611151030
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: UNION PACIFIC CDC/YWCA OF GREATER L.A.
FACILITY NUMBER: 198015657
VISIT DATE: 07/15/2024
NARRATIVE
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Based on interviews conducted, The “preponderance of the evidence” standard has been met. The allegation child was injured while in care is substantiated.

Exit interview was conducted with Norma Gonzalez, Site Supervisor. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 54-CC-20240611151030
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: UNION PACIFIC CDC/YWCA OF GREATER L.A.
FACILITY NUMBER: 198015657
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2024
Section Cited
CCR
101223(a)(1)
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Title 22, Division 12, Chapter 1, Article 06. Continuing Requirements
Personal Rights – 101223(a)(1)
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:

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Per Director, sit in closer for supervision of those who tend to bite. Site Director will have a staff meeting and more redirection. Books on Biting for training.
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Based on confidential interviews, the licensee did not comply with the section cited above, child bit child on multiple occasions, Which poses a potential health, safety or personal rights risk to persons 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: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5