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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418808
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:32:12 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
05/14/2021 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20210514130447
FACILITY NAME:BOLES FAMILY CHILD CAREFACILITY NUMBER:
197418808
ADMINISTRATOR:BOLES, JOVELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 658-1774
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 7DATE:
07/27/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jovell Boles, LicenseeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not maintain a copy of child's emergency contact information.
INVESTIGATION FINDINGS:
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On 07/27/2021 at 2:00 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced visit and met and informed Jovell Boles, licensee, of the reason for the visit: Delivery of report finding against the alleged complaint: Licensee did not maintain a copy of child's emergency contact information.
After conducting multiple interviews, record reviews, and obtaining a written declarative statement from licensee, the following conclusion has been reached: Substantiated - A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
The facility was cited a Type B deficiency according to California Code of Regulations Title 22 (See LIC 9099D report for deficiencies). Licensee is to post notice of Site Visit for 30 Days, failure to do so will result in $100 immediate civil penalty. An exit interview and a copy of this report along with Appeal Rights were explained and provided to Jovell Boles, licensee.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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 3
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
05/14/2021 and conducted by Evaluator Miriam Cohen
COMPLAINT CONTROL NUMBER: 30-CC-20210514130447

FACILITY NAME:BOLES FAMILY CHILD CAREFACILITY NUMBER:
197418808
ADMINISTRATOR:BOLES, JOVELLFACILITY TYPE:
810
ADDRESS:11538 SPINNING AVENUETELEPHONE:
(310) 658-1774
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 7DATE:
07/27/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jovell Boles, LicenseeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Child sustained unexplained injuries while in care
Staff handled day care child in a rough manner
Staff yelled at child in care

INVESTIGATION FINDINGS:
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On 07/27/2021 at 2:00 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced visit and met and informed Jovell Boles, licensee, of the reason for the visit: Delivery of report finding against the alleged complaints: Child sustained unexplained injuries while in care; Staff handled day care child in a rough manner; Staff yelled at child in care.
Based upon the following observations below, facts revealed that there is not a preponderance of the evidence to support that the licensee committed the allegation mentioned above:
1. Interviews – all interviews conducted with children revealed that injury (tooth loss) sustained by C8 happened as a result of an accident when jumping inside the trampoline.
2. Interviews – all interviews conducted with children did not reveal evidence that day care children were handled in a rough manner by staff members.
3. Interviews – all interviews conducted with children did not disclose staff members yell at children in care
4. Video viewing – the video viewed did not show evidence of staff handling day care child in a rough manner nor staff yelling at child in care.
Therefore, the following conclusion has been determined concerning the above allegations: Unsubstantiated - A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 30-CC-20210514130447
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: BOLES FAMILY CHILD CARE
FACILITY NUMBER: 197418808
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
102421(b)
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Childs Records. The licensee shall maintain, in each child’s record, a copy of the emergency information card required in Section 102417(g) (7).
This requirement is not met as evidenced by observation and records review conducted during conducted during virtual visit on 05/19/2021. Upon several

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POC: Licensee agrees to watch a video from Resources from Parents and Providers
https://ccld.childcarevideos.org/family-child-care-providers/
on Record Keeping on Family Child Care Home and submit a short summary to the LPA, via email, no later

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requests, o5/19/21, 07/22/2021, and 07/23/2021, licensee was unable to provide proof of emergency information card for C8. Although C8 no longer attends the above
FCCH, this is a Type B violation as it poses a potential risk to the health and safety of children in care.
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than August 13, 2021, end of business day
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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: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC9099 (FAS) - (06/04)
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