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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270248
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:35:34 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2023 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230420101319
FACILITY NAME:SOUTH COAST METRO CHILDREN'S VILLAGEFACILITY NUMBER:
304270248
ADMINISTRATOR:KETTERER, MAMIFACILITY TYPE:
850
ADDRESS:1510 BROOKHOLLOW DRIVETELEPHONE:
(714) 751-5437
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:87CENSUS: 50DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director, Mami KettererTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility failed to report incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 04/24/2023. LPA met with the director, Mami Ketterer and informed the purpose of the investigation inspection. Census was taken as follow: 10 napping toddlers and 40 napping preschool children with 3 staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 4/20/2023 a complaint was filed with the Department alleging the facility failed to report an incident. During the investigation, LPA Nguyen conducted 2 physical plant inspections dated 4/24/23 and 6/20/23 , interviewed complainant, 2 staff members, reviewed a child file, obtained CPS report, police report, a parent handbook, and a copy of the children's roster.

Continued on Page 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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 5
Control Number 06-CC-20230420101319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SOUTH COAST METRO CHILDREN'S VILLAGE
FACILITY NUMBER: 304270248
VISIT DATE: 06/20/2023
NARRATIVE
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Page 9099C

During the staff interviews, Staff 2 (S2) stated while changing child’s diaper, S2 noticed some red spots on the child’s arm. S2 notified the director, director than notified the parents. Parent picks up the child and stated would take child to the doctor. Director stated that CPS was at the facility in August 2022 and the Santa Ana police contacted the facility in April 2023.

LPA reviewed the CPS report and CPS concluded the allegation of physical abuse was inconclusive.

Santa Ana Police Report was obtained and indicated will remain on file as an information report and will be closed; however, subject to re-evaluation, pending additional information indicative of a criminal at.

Based on interviews conducted with staff, it was determined that the facility did not report the incident to Community Care Licensing (CCL). 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)(1)(B) Reporting Requirements.

Exit interview was conducted with Director Mami Ketterer. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The Director was provided with a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20230420101319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SOUTH COAST METRO CHILDREN'S VILLAGE
FACILITY NUMBER: 304270248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
101212(d)(1)(B)
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101212 Reporting Requirements (d) Upon the occurrence..., a report shall be made to the Dept by telephone... (d)(2) below shall be submitted to the Dept within seven days... (1) Events reported... (B) Any injury to any child that requires medical treatment. This is a potential Health and Safety risk to the children in care.
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The Director stated they will make sure they report any incident that requires medical treatment within 24 hours via phone call and submit a written incident report within 7 days. Director will submit LIC624 Unusual incident report by 06/30/23.
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Based on interviews conducted by LPA, it was determined that the facility did not report the incident requires medical treatment to community care licensing office. This is a potential Health and Safety risk to 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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2023 and conducted by Evaluator Cindy Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230420101319

FACILITY NAME:SOUTH COAST METRO CHILDREN'S VILLAGEFACILITY NUMBER:
304270248
ADMINISTRATOR:KETTERER, MAMIFACILITY TYPE:
850
ADDRESS:1510 BROOKHOLLOW DRIVETELEPHONE:
(714) 751-5437
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:87CENSUS: 50DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director, Mami KettererTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Child sustained injury at school.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 04/24/2023. LPA met with the director, Mami Ketterer and informed the purpose of the investigation inspection. Census was taken as follow: 10 napping toddlers and 40 napping preschool children with 3 staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 4/20/2023 a complaint was filed with the Department alleging a child sustained injury at school.

During the investigation, LPA Nguyen conducted 2 physical plant inspections dated 4/24/23 and 6/20/23, interviewed complainant, 2 staff members, reviewed a child file, obtained CPS report, police report, a parent handbook, and a copy of the children's roster.

Continued on Page 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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 5
Control Number 06-CC-20230420101319
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SOUTH COAST METRO CHILDREN'S VILLAGE
FACILITY NUMBER: 304270248
VISIT DATE: 06/20/2023
NARRATIVE
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Page 9099C

During the staff interviews, Staff 2 (S2) stated while changing child’s diaper, S2 noticed some red spots on the child’s arm. S2 notified the director, director than notified the parents . Parent stated that child was going to be pick up and taken to the doctor.

LPA reviewed the CPS report and CPS concluded the allegation of physical abuse was inconclusive.

Santa Ana Police Report was obtained and indicated will remain on file as an information report and will be closed; however, subject to re-evaluation, pending additional information indicative of a criminal act.

Based on LPA’s interviews and document reviews, the preponderance of evidence was not met, therefore the above allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Director, Mami Ketterer. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5