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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412437
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:55:30 AM

Document Has Been Signed on 03/27/2023 11:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DOTSIES TOTS ENRICHMENT CENTERFACILITY NUMBER:
197412437
ADMINISTRATOR:ADAMS, TRACIEFACILITY TYPE:
850
ADDRESS:1480 WEST COMPTON BLVD.TELEPHONE:
(310) 637-6003
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 24DATE:
03/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Katrina Williams, Site Supervisor/TeacherTIME COMPLETED:
11:28 AM
NARRATIVE
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On March 27, 2023 at 11:15am, Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced complaint inspection for the purpose of delivering findings for the above allegation. Upon arrival, LPA met with Katrina Williams, Site Supervisor/Teacher and toured the facility. Upon arrival, there were 24 staff and 6 children in care.

During the investigation, LPA Chambers conducted interviews with Staff and reviewed relevant department database “FAS”, regarding the above allegation.

LPA reviewed the FAS database on 02/28/23 attempting to locate an unusual incident report for the incident occurring on February 10, 2023. LPA could not locate any unusual incident reported by the center via phone call or required written LIC624 as required by Title 22 Reporting Requirements reporting a child injury that requires medical treatment. In addition, LPA spoke to staff who stated they were not aware they needed to report the incident that occurred on February 10, 2023 because they were not aware of the incident until after the date of occurrence.

Based on statements made by staff, interviews with staff, and record review in the department database-FAS, there is a preponderance of the evidence to prove that the facility failed to report the incident that occurred on 02/20/23, a child injury requiring medical treatment. Therefore, the allegation is substantiated.
Deficiency was cited during today's inspection.
Appeal rights were provided and discussed with the facility representative.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Site Supervisor/Teacher, Katrina Williams
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/27/2023 11:55 AM - It Cannot Be Edited


Created By: Dayna Chambers On 03/27/2023 at 11:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: DOTSIES TOTS ENRICHMENT CENTER
FACILITY NUMBER: 197412437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2023
Section Cited
CCR
101212(d)(1)(B)

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Citation: 101212(d)(1)(B)- reporting requirements: Title 22, Division 12, Chapter 1, Article 06. Continuing Requirements (d) Upon the occurrence, during the operation of the childcare 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. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (B) Any injury to any child that requires medical treatment.
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Per Licensee, an LIC624 written report will be submitted to the MPSW Office – for incident occurring 02/10/23. LPA provided Incident Report email address: MPSWINCIDENTREPORTS@dss.ca.gov
LPA provided copy of Reporting Requirements Title 22 regulations
VIDEO: Child Care Reporting
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This requirement is not met as evidenced by Based on statements made by staff, interviews with staff, and record review in the department database-FAS, there is a preponderance of the evidence to prove that the facility failed to report the incident that occurred on 02/20/23, a child injury requiring medical treatment. which poses/posed a potential Health, Safety, or Personal Rights Risk to children in care.
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Requirements: : www.ccld.childcarevideos.org
QUESTIONS TO ANSWER:
1. What reports am I required to submit to Licensing?
2. How and when should I file these reports?
3. Am I required to file reports with agencies other than Community Care Licensing?
4. What happens when I file a report?



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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.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Dayna Chambers
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023


LIC809 (FAS) - (06/04)
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