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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191605004
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:07:28 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2021 and conducted by Evaluator Shandra Powell
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20210617131305
FACILITY NAME:ACADEMY FOR EARLY LEARNINGFACILITY NUMBER:
191605004
ADMINISTRATOR:TIFFANY MCDUFFIEFACILITY TYPE:
850
ADDRESS:1014-1020 N. PARK AVENUETELEPHONE:
(310) 672-3777
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY:51CENSUS: 11DATE:
09/17/2021
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Tiffany McDuffie, DirectorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Personal Rights: Facility staff served daycare child with sever peanut allergy: a peanut butter and jelly sandwich
Reporting Requirements: Facility staff did not report a daycare child's condition to the representative/parent
INVESTIGATION FINDINGS:
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A complaint inspection was conducted by Licensing Program Analyst (LPA), Shandra Powell. Present during today's visit are 11 preschool children and 2 staff. The reason for today's inspection is to deliver findings on the above allegations.

LPA interviewed the complainant, the licensee, and staff who may have been present involving the above allegations relating to personal rights. The two children that were interviewed corroborated with the allegation child ingested peanut butter during child care hours. In addition to this, the staff that were interviewed did notice the child was not feeling well and the parent was not contacted nor was the parent or guardian told about the child not feeling well at time of pick up until representative inquired.
LPA has determined that a preponderance of evidence standards has been met. Therefore, the above allegations are found to be SUBSTANTIATED. See 9099D for Violations of the California Code of Regulations, Title 22.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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
Control Number 30-CC-20210617131305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ACADEMY FOR EARLY LEARNING
FACILITY NUMBER: 191605004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2021
Section Cited
CCR
101212(d)(1)(B)
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REPORTING REQUIREMENTS:
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
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Director will have meeting with all staff regarding reporting requirements. Director will send LPA sign in sheet from meeting by POC date 09/18/2021.
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Department's next working day and during its normal business hours The reqirement was not met due to the
Facility did not submit a written report to licensing concerning the incident that occurred.
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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: Mary Ruiz
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 30-CC-20210617131305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ACADEMY FOR EARLY LEARNING
FACILITY NUMBER: 191605004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2021
Section Cited
CCR
101223(a)(2)
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PERSONAL RIGHTS:
The licensee shall ensure that each child is accorded the following personal rights:
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director agrees to do the following: Submit written proof on how the facilty plans to ensure the health and safety of children in care with peanut butter allergies by POC date 09/21/2021.
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 The requirement was not met due to A child in care was given peanut butter products during child care hours. Child has on file that he is alergic. This is an immediate threat to the child's Health and Safety.
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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: Mary Ruiz
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 30-CC-20210617131305
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ACADEMY FOR EARLY LEARNING
FACILITY NUMBER: 191605004
VISIT DATE: 09/17/2021
NARRATIVE
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Director was informed that they need to post this report for 30 days. In addition to this, they need to provide a copy of this report to all parents enrolled and newly enrolled parents within the next 12 months. Parents must sign an Addendum Acknowledging Receipt of the licensing reports. The signed Acknowledgement forms must be placed in the children's files in order to avoid civil penalties. An exit interview was conducted with Director McDuffie and Appeal Rights were issued and discussed.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC9099 (FAS) - (06/04)
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