197494575-6-28-2024-58-CC-RRAS-D6NSLU-20240628135855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197494575
Report Date: 06/24/2024
Date Signed: 06/28/2024 09:05:22 AM

Unsubstantiated

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
03/26/2024 and conducted by Evaluator Elicia Calvillo

COMPLAINT CONTROL NUMBER: 58-CC-20240326120548

FACILITY NAME:	DEVONSHIRE INFANT CENTER		FACILITY NUMBER:	197494575
ADMINISTRATOR:	JACQUELINE SORIA LOPEZ		FACILITY TYPE:	830
ADDRESS:	21203 DEVONSHIRE STREET		TELEPHONE:	(818) 700-2821
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	46	CENSUS: 2	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Mercedes Diaz, Director		TIME COMPLETED:	06:25 PM

ALLEGATION(S):

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Staff did not ensure child's diaper was changed in a timely manner

INVESTIGATION FINDINGS:

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On 06/ 24/2024 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegation. LPA identified self and met with Mercedes Diaz, Director who allowed entry to facility and provided LPA a guided tour of inside and outside of the facility Upon arrival there were 2 children and 1 staff presents.

Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, LIC 500 Personnel Report, Devonshire Preschool & Infant Center Incident Report, Copy of Parent Handbook, Copy of Bright Wheel App Parent Logs, and interviewed staff and parents.

During today’s visit, LPA addressed the allegation that Staff did not ensure child's diaper was changed in a timely manner. Per reporting party child’s diaper changes were not frequent resulting in a rash.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

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 8

Control Number 58-CC-20240326120548

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: 06/24/2024

NARRATIVE

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The allegation that the Staff did not ensure child's diaper was changed in a timely manner, has been found to be unsubstantiated. Per Director, every child has a diaper change every 2 hours or as needed and parents are notified through Bright Wheel App. Per staff, diaper changes are every 2 hours or as needed and parents receive a message in the Bright Wheel App. No children were interviewed due to their age.

Based on LPA’s investigation, documents obtained, and statements obtained, it has been determined that the complaint alleging staff did not ensure child's diaper was changed in a timely manner is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Mercedes Diaz, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 8

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
03/26/2024 and conducted by Evaluator Elicia Calvillo

COMPLAINT CONTROL NUMBER: 58-CC-20240326120548

FACILITY NAME:	DEVONSHIRE INFANT CENTER		FACILITY NUMBER:	197494575
ADMINISTRATOR:	JACQUELINE SORIA LOPEZ		FACILITY TYPE:	830
ADDRESS:	21203 DEVONSHIRE STREET		TELEPHONE:	(818) 700-2821
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	46	CENSUS: 2	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Mercedes Diaz, Directore		TIME COMPLETED:	06:25 PM

ALLEGATION(S):

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9

Staff did not prevent day care child from physically harming other children

INVESTIGATION FINDINGS:

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5
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7
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10
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12
13

On 06/ 24/2024 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegation. LPA identified self and met with Mercedes Diaz, Director who allowed entry to facility and provided LPA a guided tour of inside and outside of the facility Upon arrival there were 2 children and 1 staff present.

During today’s visit, LPA addressed the allegation that staff did not prevent day care child from physically harming other children. Per reporting party, staff did not prevent day care child from physically harming other children.

Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, LIC 500 Personnel Report, Devonshire Preschool & Infant Center Incident Report, Copy of Parent Handbook, Copy of Bright Wheel App Parent Logs, and interviewed staff and parents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 8

Control Number 58-CC-20240326120548

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: 06/24/2024

NARRATIVE

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The allegation that the staff did not prevent day care child from physically harming other children, has been found to be unsubstantiated. Per director, if a child is harmed by another child then both parents are notified, an Incident Report is completed, and the parent is given a copy of the Incident Report when child is picked up. Per staff, parents have not had any concerns about a child harming other children. Per parents, they did not witness another child harming other children. No children were interviewed due to their age.

Based on LPA’s investigation, documents obtained, and statements obtained, it has been determined that the complaint alleging staff did not prevent day care child from physically harming other children manner is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Mercedes Diaz, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role..

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 8

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
03/26/2024 and conducted by Evaluator Elicia Calvillo

COMPLAINT CONTROL NUMBER: 58-CC-20240326120548

FACILITY NAME:	DEVONSHIRE INFANT CENTER		FACILITY NUMBER:	197494575
ADMINISTRATOR:	JACQUELINE SORIA LOPEZ		FACILITY TYPE:	830
ADDRESS:	21203 DEVONSHIRE STREET		TELEPHONE:	(818) 700-2821
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	46	CENSUS: 2	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Mercedes Diaz, Directore		TIME COMPLETED:	06:25 PM

ALLEGATION(S):

1
2
3
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5
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8
9

Child sustained unexplained injury while in care

INVESTIGATION FINDINGS:

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3
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5
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7
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10
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12
13

On 06/ 24/2024 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegation. LPA identified self and met with Mercedes Diaz, Director who allowed entry to facility and provided LPA a guided tour of inside and outside of the facility Upon arrival there were 2 children and 1 staff present.

During today’s visit, LPA addressed the allegation that child sustained unexplained injury while in care.Per the reporting party, child sustained an injuy and staff would not explain how it happened.

Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, LIC 500 Personnel Report, Devonshire Preschool & Infant Center Incident Report, Copy of Parent Handbook, Copy of Bright Wheel App Parent Logs, and interviewed staff and parents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 8

Control Number 58-CC-20240326120548

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: 06/24/2024

NARRATIVE

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The allegation that the child sustained unexplained injury while in care, has been found to be unsubstantiated. Per director, if a child is harmed by another child then both parents are notified, an Incident Report is completed, and the parent is given a copy of the Incident Report when child is picked up. Per staff if a child has an injury, an Incident Report is completed, and parents are notified. Per parents, staff completed an Incident Report if child has an injury and parent signs the report at the time of pick up. No children were interviewed due to their age.

Based on LPA’s investigation, documents obtained, and statements obtained, it has been determined that the complaint alleging child sustained unexplained injury while in care is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 8

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
03/26/2024 and conducted by Evaluator Elicia Calvillo

COMPLAINT CONTROL NUMBER: 58-CC-20240326120548

FACILITY NAME:	DEVONSHIRE INFANT CENTER		FACILITY NUMBER:	197494575
ADMINISTRATOR:	JACQUELINE SORIA LOPEZ		FACILITY TYPE:	830
ADDRESS:	21203 DEVONSHIRE STREET		TELEPHONE:	(818) 700-2821
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	46	CENSUS: 2	DATE:	06/24/2024
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Mercedes Diaz, Directore		TIME COMPLETED:	06:25 PM

ALLEGATION(S):

1
2
3
4
5
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7
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9

Staff did not ensure cup used by child was free of mold

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 06/ 24/2024 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted a complaint visit to deliver findings on the above allegation. LPA identified self and met with Mercedes Diaz, Director who allowed entry to facility and provided LPA a guided tour of inside and outside of the facility Upon arrival there were 2 children and 1 staff present.

During today’s visit, LPA addressed the allegation that Staff did not ensure cup used by child was free of mold. Per reporting party childs sippy cup was dirty and moldy.

Throughout the course of the investigation, LPA obtained the LIC 9040 Child Care Facility Roster, LIC 500 Personnel Report, Devonshire Preschool & Infant Center Incident Report, Copy of Parent Handbook, Copy of Bright Wheel App Parent Logs, and interviewed staff and parents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 7 of 8

Control Number 58-CC-20240326120548

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: 06/24/2024

NARRATIVE

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The allegation that the staff did not ensure cup used by child was free of mold, has been found to be unsubstantiated. Per director, children’s sippy cups are kept in area in the room and parents take home daily to wash. Per the staff, sippy cups are taken home daily by parents to wash and returned the next day. Per parents, sippy cups are taken home each day to wash then returned to the next day and there was a changed to the process around the time new director was hired.

Based on LPA’s investigation, documents obtained, and statements obtained, it has been determined that the complaint alleging staff did not ensure cup used by child was free of mold unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Mercedes Diaz, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024

LIC9099 (FAS) - (06/04)

Page: 8 of 8