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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494575
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:56:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 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
11/28/2023 and conducted by Evaluator Suzette Ornelas
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20231128090624
FACILITY NAME:DEVONSHIRE INFANT CENTERFACILITY NUMBER:
197494575
ADMINISTRATOR:JACQUELINE SORIA LOPEZFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:46CENSUS: 11DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Jacqueline Soria Lopez-DirectorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Facility has roaches
INVESTIGATION FINDINGS:
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On 12/7/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced follow up complaint inspection for the purpose of delivering the findings for the above-mentioned allegation. Upon arrival, LPA were greeted and let into the facility by Director, Jacqueline Soria Lopez, to whom the reason for the inspection was announced. LPA toured the facility and observed 11 daycare children and 3 staff.

Throughout the course of the investigation, LPA Ornelas made observations, conducted interviews with Reporting Party, 2 staff; and documentation was obtained in the form of an invoice.

-Pertaining to the allegation that - Facility has roaches
According to the reporting party (RP) roaches are present in the infant and toddler building.
LPA interviewed Staff 1 (S1) who stated that cockroaches were occasionally observed at the facility while children were present. Staff 2 (S2) stated that in November, a few cockroaches were observed inside the facility and might have came from outside (alley located behind facility). Facility contacted pest control service and service was provided while no children were present.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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 58-CC-20231128090624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: DEVONSHIRE INFANT CENTER
FACILITY NUMBER: 197494575
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2023
Section Cited
CCR
101238(a)(1)
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101238(a)(1) Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
(1) The licensee shall take measures to keep the center free of flies, other insects, and rodents.
This requirement is not met as evidence by:
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DIrector provided LPA with an invoice from 12/4/2023 showing that a pesticide company provided services while no children were present. Per Director, the next scheduled service will be conducted one month from 12/4/2023.
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Based on observations, interviews, Licensee did not comply with the section cited above. According to S1. S3 cockroaches were observed, which poses an potential health, safety or personal rights risk to persons 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: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 58-CC-20231128090624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DEVONSHIRE INFANT CENTER
FACILITY NUMBER: 197494575
VISIT DATE: 12/07/2023
NARRATIVE
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LPA reviewed invoice for New World Pest Control Inc. dated 12/4/2023, which states that a monthly service was provided. Per Director, pest control services are provided monthly.

Based on the information obtained through observations and interviews, the allegation is substantiated. A substantiated finding means that the complaint is substantiated and the allegation is valid because the preponderance of the evidence standard has been met.

Facility was cited a type B deficiency

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Director, Jacqueline Soria Lopez.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3