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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191801302
Report Date: 07/05/2024
Date Signed: 07/05/2024 03:05:59 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
06/06/2024 and conducted by Evaluator Katrina Chicote
PUBLIC
COMPLAINT CONTROL NUMBER: 54-CC-20240606121857
FACILITY NAME:CHILDTIME CHILDRENS'S CENTERFACILITY NUMBER:
191801302
ADMINISTRATOR:ANA FRAGOSO-TOVALINFACILITY TYPE:
830
ADDRESS:4820 S. EASTERN AVE. SUITE #FTELEPHONE:
(323) 721-0552
CITY:LOS ANGELESSTATE: CAZIP CODE:
90040
CAPACITY:24CENSUS: 8DATE:
07/05/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ana Fragoso-Tovalin, DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Food Service - Child was served food by staff to which the child's record indicates there is an allergy
INVESTIGATION FINDINGS:
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On 07/05/2024 at 1:00 PM Licensing Program Analysts (LPAs) Katrina Chicote and Peter Bishop conducted an Unannounced Complaint Inspection for the purpose of delivering findings to the above allegation. LPAs were provided a guided tour of the facility. Census was taken. LPAs observed eight infants with three staff at time of inspection.

During the investigation LPAs made observations, conducted interviews, and obtained records. Information gathered from staff interviews consistently state that infant was served Cheese Ravioli on the date of incident, which confirms information provided in complaint. LPAs record review of Menu also confirm this as the served food item on the date of incident. LPAs obtained and reviewed pertinent documents such as Infant's allergy list and ingredient list for Cheese Ravioli, upon record review conducted LPAs observed that ingredients listed on child's allergy list match some ingredients in the Cheese Ravioli. Staff interviews provided corroborating information that though they were aware that there were ingredients listed that match Infant's
Report Continues - Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024
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-20240606121857
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: CHILDTIME CHILDRENS'S CENTER
FACILITY NUMBER: 191801302
VISIT DATE: 07/05/2024
NARRATIVE
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allergy list they were unsure if that includes cheese, which is made from Cow's Milk, as it did not indicate it on the list but did not seek to clarify information with Infant's Authorized Representative. Staff interviews also stated that Infant had previously eaten this item before without incident and do not believe the ingredients had changed since the previous time it was served. LPAs obtained corroborating information that staff did not reach out for clarification and stated that Infant's allergies includes all items made with that ingredient. FR states they did reach out to Infant's Authorized Representative for clarification but did not have documentation to indicate any updates in regards to allergy list and what food could and could not be served.

Based on the available information obtained from observations, record review, and interviews there is a preponderance of evidence that the allegation of Child was served food by staff to which the child's record indicates there is an allergy is SUBSTANTIATED. In this case, there is concrete evidence to state that the above allegation occurred at the facility.

Based on this information the following deficiencies on the LIC 9099D are being cited today, 07/05/2024.

LPAs informed Facility Representative Ana Fragoso-Tovalin that this report dated 07/05/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.



Also, LPAs informed the Facility Representative to provide a copy of this licensing report dated 07/05/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representative, Ana Fragoso-Tovalin.
Report Ends - Page 2 of 2
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 54-CC-20240606121857
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: CHILDTIME CHILDRENS'S CENTER
FACILITY NUMBER: 191801302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2024
Section Cited
CCR
1012277(7)(B)
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101227 (7) (B) Food Services
(7) Modified diets prescribed by a child's physician as a medical necessity shall be provided. (B ) A child shall not be served any food to which the child's record indicates he/she has an allergy.
This regulation was not met as evidenced by:
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FR states they have updated procedures moving forward in regards to children with severe allergies to bring their own food, severe allergies will be defined as requiring an epipen. FR provided declaration in regards to updated policy. Clearing deficiency on this date.
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Based on LPAs observations, record reviews, and interview Licensee did not meet above regulation. Staff interviews and record reviews provided corroborating information that Infant was served food on allergy list. This poses an immediate health, safety, and personal rights risk to 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: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024
LIC9099 (FAS) - (06/04)
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