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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191606870
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:04:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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
10/02/2024 and conducted by Evaluator Ashley Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20241002095524
FACILITY NAME:CITY OF CARSON COMMUNITY SERVICE CENTERFACILITY NUMBER:
191606870
ADMINISTRATOR:RAQUEL RIVERAFACILITY TYPE:
850
ADDRESS:801 E. CARSON ST.TELEPHONE:
(310) 835-0212
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:70CENSUS: 44DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Dani Cook/ Human Service Program ManagerTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff pinched day care child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Calderon and Andrea Carter arrived at the above licensed facility for the purpose of delivering findings for the above allegation. LPA met with Staff Katherine Fernandez who granted LPAs entrance to the facility. LPA disclosed purpose of today's visit with Lead Teacher Tomiko Barrom. LPAs was given permission by T.Barrom to do a self guided tour of the facility.

At 11:05am, Human Service Program Manager Dani Cook was notified, LPA met with D.Cook and disclosed the purpose of today's visit. D.Cook was interviewed.

Regarding the above allegation: Staff pinched day care child. Information gathered during record review revealed on facility email dated 9/26/24 Staff #1 (S1) statement regarding incident dated 9/24/24 S1 admits to using discipline strategy on C1 pinching child. During S1 interview with LPA Calderon conducted 10/8/24, S1 stated used a Sensory Input Strategy and applied pressure along C1's arm. Based on interviews conducted with staff there was an unauthorized discipline strategy used on C1. (cont.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 3
Control Number 54-CC-20241002095524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CITY OF CARSON COMMUNITY SERVICE CENTER
FACILITY NUMBER: 191606870
VISIT DATE: 11/26/2024
NARRATIVE
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There is a open Law Enforcement investigation that remains open regarding the above allegation/ incident with S1 and C1.

Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D / Type B. Appeal rights were provided and exit interview conducted with Human Service Program Manager Dani Cook and Community Service Super Intendant Bobby Grove. The Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20241002095524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CITY OF CARSON COMMUNITY SERVICE CENTER
FACILITY NUMBER: 191606870
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
CCR
101223(a)(3)
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(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat... but not limited...:interference w/ functions of daily living...eating, sleeping or toileting... physical functioning.
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Facility will conduct staff training regarding Personal Rights of a Child, facility will provide material given to staff during training and a sign in sheet to be given to LPA Calderon by poc due date. If S1 returns to the facility S1 will get training and documentations to LPA Calderon upon S1 return.
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This requirement was not met as evidenced by: LPA Calderon received email documentation regarding S1 statement regarding C1 and stated admits to using discipline strategy on C1 pinching child.
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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: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3