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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019065
Report Date: 10/09/2024
Date Signed: 10/09/2024 03:53:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 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
08/08/2024 and conducted by Evaluator Stephanie Li
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20240808115441
FACILITY NAME:BLOOMING FLOWERS CHILD CARE CENTERFACILITY NUMBER:
198019065
ADMINISTRATOR:THOMAS, JAZMYNEFACILITY TYPE:
850
ADDRESS:680 E. ARROW HIGHWAYTELEPHONE:
(909) 399-0003
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:60CENSUS: 5DATE:
10/09/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director Elaine DavisTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Personal Rights
Lack of care and supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced site inspection to present the findings of the above complaint allegations. It was nap time upon arrival, Director was not present. Assistant teacher opened door for LPA and said Elaine was not present. LPA called Elaine and announced visit, Director stated she needed to grab some lunch and will return. Licensing staff met with Director Elaine Davis to whom the reason for the visit was explained. Director provided a tour of the facility. Present during the inspection was 3 staff and 5 children.

During the investigation Licensing staff conducted interviews with supervisor and facility staff. Licensing staff also obtained several documents related to the complaint allegation, including but not limited to, a copy of the Facility Roster, Incident and Ouch reports from facility, parent handbook, and employee policies and procedures and staff manual. Video recordings were also reviewed during this investigation. Child’s files were also reviewed during this investigation. *continued on next page
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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 3
Control Number 33-CC-20240808115441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065
VISIT DATE: 10/09/2024
NARRATIVE
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Based on statements obtained from staff interviewed, record review, and video review, proof was found and disclosures were made from staff regarding staff not notifying parent of child’s injury due to lack of supervision corroborating the allegation, therefore, the above allegations are deemed SUBSTANTIATED. California Code of Regulations, Title 22 are being cited on the attached LIC9099D.

At this time, a Type-A deficiency is being cited. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

One (1) Type A - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.
A notice of site visit was given to licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was reviewed and appeal rights provided with Director Elaine Davis.

*End
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 33-CC-20240808115441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2024
Section Cited
CCR
101223(a)(2)
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(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met evidenced by:
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Per director, she is setting up play areas with more toys and equipment for the chlidren to minimize conflicts and eliminating the nap room from being used as the play area. LPA observed that the play area has been moved to outside the nap room as of today 10/9/24.
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child was bit in the ear by another child while under the supervision of an aide
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Type A
10/10/2024
Section Cited
CCR
101229(a)(1)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement was not met evidenced by:
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Per director, she will provide more training, pertaining to the topics of first aid procedures and incident documenting procedures and notifying director of injuries. She will email meeting agenda and staff sign in to LPA by 10/23/24.
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Child was not provided first aid for injury sustained and parent was not notified of injury.
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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: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3