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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290221
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:20:21 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 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
08/26/2022 and conducted by Evaluator Crystal Green
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20220826161417
FACILITY NAME:LA CANADA PRESBYTERIAN CHURCH INFANT CARE CENTERFACILITY NUMBER:
191290221
ADMINISTRATOR:DIANA URTEAGAFACILITY TYPE:
830
ADDRESS:626 FOOTHILL BOULEVARDTELEPHONE:
(818) 790-6708
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY:24CENSUS: 18DATE:
10/11/2022
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Diana UrteagaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Reporting Requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Green an unannounced complaint inspection to deliver findings regarding the allegation above. Upon arrival licensing staff met with Director, Diana Urteaga. Census was taken.

The allegation states that the facility did not meet reporting requirements. Reporting Party (RP) alleges that an incident occurred at the facility resulted in a child slipping and falling from a slide in the outdoor playarea and was not reported to the department. During this investigation, Licensing staff conducted interview with the Director. It was confirmed by the Director, that an incident occurred at the facility on 05/06/2022. The child did not substain injuires. The parents of the child was notified immediately and was provided an ouch report that day the occured. However, the department did not receive an unusual incident report in a timely manner. Licensing staff obtained a written report of the incident during this investiagtion.

Report Continues Page 1 of 2

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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 33-CC-20220826161417
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: LA CANADA PRESBYTERIAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 191290221
VISIT DATE: 10/11/2022
NARRATIVE
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Based on interviews conducted during this investigation, the above allegation is substantiated at this time. California Code of Regulations (Title 22, Division & Chapter) relating to this allegation has been cited on LIC 9099-D.

An exit interview was conducted with the Director, Diana Urteaga. The Director was provided a copy of their appeal rights (LIC 9058), and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


Report Ends Page 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20220826161417
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: LA CANADA PRESBYTERIAN CHURCH INFANT CARE CENTER
FACILITY NUMBER: 191290221
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2022
Section Cited
CCR
101212(d)(1)
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d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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Per Director, conducted an staff meeting on 09/01/2022 to discuss reporting requirements of the facility. LPA obtained a written copy of the incident report.
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The requirement is not met as evidenced by disclosures made by the director during interview conducted on 09/02/2022. This poses a potential risk to the health and safety of 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: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4