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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198016984
Report Date: 02/15/2023
Date Signed: 02/15/2023 02:22:06 PM

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
02/09/2023 and conducted by Evaluator Monique Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20230209095509
FACILITY NAME:ENGBERG FAMILY CHILD CAREFACILITY NUMBER:
198016984
ADMINISTRATOR:ENGBERG, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 233-9872
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 10DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Licensee, Toni EngbergTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Licensee administered medication to day care child without parent consent.
INVESTIGATION FINDINGS:
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On February 15, 2023 at 9:25 am, Licensing Program Analysts (LPAs) Monique Ayala and Rosaura Valenzuela conducted an unannounced inspection at the facility noted above and met with Licensee, Toni Engberg. The purpose of the inspection was to announce the complaint investigation for the allegation noted above. Due to the supportive evidence submitted to the Department by the complainant and confidential interviews conducted, LPAs were able to also deliver the complaint investigation findings.

LPA Ayala conducted a telephone interview with the complainant and received supportive documentation for the complaint allegation. During today's inspection, LPA Ayala conducted confidential interviews with the Licensee, three (3) personnel, and four (4) children. LPAs also conducted a walk through of the facility accompanied by the Licensee.

The confidential interviews revealed that the Licensee instructed a personnel to adimister melatonin to a child in order for the child to nap. LPA obtained supportive documentation to support these disclosures from multiple individuals.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 3
Control Number 54-CC-20230209095509
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
VISIT DATE: 02/15/2023
NARRATIVE
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Per Licensee, no children currently enrolled in care are required to take medication. Licensee disclosed that medication is kept in a cabinet located in the kitchen that has a child safety latch as well as in the "off-limit" master bedroom. LPAs observed the storage of medication. LPAs also observed a container of Nature Made Back to Sleep tablets inside the "off-limit" master bathroom. Licensee denied the complaint allegation and denied that any children have been given melatonin.

Based on the information obtained, there is a preponderance of the evidence to prove that a child was administered medication without the parents or guardian consent. Therefore, the allegation is substantiated. Appeal rights are included with this report and deficiency was cited.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Acknowledgment of Receipt of Licensing Report (LIC 9224) was also provided.

Exit interview conducted and report was reviewed with Licensee, Toni Engberg.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20230209095509
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2023
Section Cited
CCR
102423(a)(4)
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Personal Rights 102423(a)(4). To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter,
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Licensee was reminded of protocols regarding adminitration of medication, parental and/or guardian consent to administer medication, and personal rights. Per Licensee, melatonin will not be given to any children in care.
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clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by:
Based on supportive documents and interviews, Licensee had melatonin administered to a child without consent for the purpose of the child taking a nap.
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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: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
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