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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198014168
Report Date: 06/10/2025
Date Signed: 06/10/2025 12:32:12 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2025 and conducted by Evaluator Monique Jessica Ayala
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20250210143619
FACILITY NAME:KIDS KLUB SAN GABRIEL / ROSEMEADFACILITY NUMBER:
198014168
ADMINISTRATOR:JILL LODATOFACILITY TYPE:
850
ADDRESS:4930 EARLE AVENUETELEPHONE:
(626) 288-4400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:149CENSUS: DATE:
06/10/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Arianna Alonzo, DirectorTIME COMPLETED:
11:52 AM
ALLEGATION(S):
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Personal Rights: Staff failed to change child's diaper
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced subsequent inspection to a complaint investigation initially found to be unsubstantiated. Upon arrival LPA met with director, Arianna Alonzo to whom the purpose of the inspection was explained. A tour of the facility was provided to licensing staff.

Children were present during the time of tour. Census was taken. There were __ children with __ staff members.

On 02/10/2025, a complaint was received alleging that staff failed to change a child’s diaper, resulting in a diaper rash on the child’s buttocks and genital area which required medical attention. During the initial investigation conducted by LPA Nolan Tcheng, there was not a preponderance of evidence to determine that the allegation did or did not happen and therefore the complaint was deemed unsubstantiated. During initial interviews, staff stated that diapers were changed every 1-2hrs or when the diaper had become soiled.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
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 4
Control Number 33-CC-20250210143619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDS KLUB SAN GABRIEL / ROSEMEAD
FACILITY NUMBER: 198014168
VISIT DATE: 06/10/2025
NARRATIVE
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They explained that the facility tablets alert staff that diapers need to be checked and staff have to manually enter that a diaper was checked/changed. Specifically, Child #1’s diaper log for 01/28/2025 was provided during the investigation as evidence which noted that child was dropped off/signed in at 8:42am, changed for wet diaper at 9:37am, and then changed again at 11:08 for another wet diaper. All staff interviewed confirmed the diaper changing procedure. On 1/28/2025, C1 had an ouch report created at 11:25am for irritated skin. On 03/12/2025 the complaint was delivered as unsubstantiated.

During an inspection by LPA Ayala, conducted on 05/01/2025, it was disclosed that the same staff previously interviewed were given a write up by administrative staff for failure to change C1’s diaper. The staff who received write ups admitted that they had not changed the child’s diaper as there was “miscommunication.” The staff explained that the child was not changed but was marked as changed. According to the write up, C1 was away from the group in another area of the facility during the regular diaper changing time. Staff #6 had entered that the diaper had been changed on the tablet, though they didn’t change the diaper themselves or confirm with Staff #3 that the diaper had been changed. Staff#6 assumed that Staff #3 had changed C1’s diaper, since according to Staff#6, C1 only feels comfortable with Staff #3.

LPA Ayala obtained copies of the write ups for Staff #2, #3, and #6. Write ups were for incident dated 01/28/2025, and explained that staff had logged a diaper change that was not actually completed. The write up also documents that the Ouch Report issued to C1’s parent failed to properly document that C1 had not received a diaper change. Write Up for Staff #6 specifically says, “On Tuesday, January 28, 2025, you logged that you completed two diaper changes on a child; one ‘Wet’ diaper at 9:37am and on ‘Wet’ diaper at 11:08am. You did not complete these two diaper changes. The child did not receive any diaper change at 9:37am…” All write ups were dated 03/07/2025 which was prior to LPA Tcheng’s initial delivered findings that took place on 03/12/2025. New information discovered supports that Kids Klub administrative staff failed to provide new information disclosed to them regarding complaint alleging that C1 was not changed which resulted in a diaper rash needing medical attention.

Based on LPA Tcheng and Ayala’s observations, interviews, record review and new information obtained, the original complaint is being amended and a new finding are being issued. The preponderance of evidence standard has been met; therefore the above allegation is being changed from UNSUBSTANTIATED to SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 Chapter 1 101223(2) Personal Rights, is being cited on the attached deficiencies page).
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 33-CC-20250210143619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDS KLUB SAN GABRIEL / ROSEMEAD
FACILITY NUMBER: 198014168
VISIT DATE: 06/10/2025
NARRATIVE
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LPA Ayala informed Director, Arianna Alonzo that this report dated 06/10/2025, documents One Type A citation, which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, and personal rights of children in care.

Also, LPA Ayala informed the Director to provide a copy of this licensing report dated 06/10/2025, that documents any Type A citation, to parent/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 (LIC9224), 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 conducted and report was reviewed with director, Arianna Alonzo. Plan of correction developed and copy of report was provided.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20250210143619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDS KLUB SAN GABRIEL / ROSEMEAD
FACILITY NUMBER: 198014168
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
06/13/2025
Section Cited
CCR
101223(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requriement was not met as evidence by: Based on interviews and
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The director will provide LPA meeting agenda for diaper log changing along with sign in sheets by POC date (06/13/2025). The facility will continue to mentor, coach and hold satff accountable as they always have, even for non-licensing requirments.
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record review, C1's diaper was not changed as there was a miscommunication between staff who logged a diaper change when it had not been done. This poses an immediate health and safety 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: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4