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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370315
Report Date: 08/16/2022
Date Signed: 08/16/2022 12:47:05 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2022 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220608091112
FACILITY NAME:KELLIE'S ACADEMY FOR KIDS, CHILD DEV. CTR.FACILITY NUMBER:
304370315
ADMINISTRATOR:FERRIA, DANAEFACILITY TYPE:
850
ADDRESS:5702 CLARK DRIVETELEPHONE:
(714) 377-0533
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY:84CENSUS: 19DATE:
08/16/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Darralynn Vadeboncoeur, AdministratorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Child was injured while in care due to lack of supervision.
INVESTIGATION FINDINGS:
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On 08/16/2022, Licensing Program Analyst (LPA) Tran conducted an in-person investigation to deliver the finding regarding allegation that Child was injured while in care due to lack of supervision. LPA Tran met with Administrator Darralynn Vadeboncoeur.

A tour around the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 19 children and 4 staff members.
A review of the Facility Personnel Report Summary on 08/16/2022 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 06/08/2022, the Regional Office received a complaint with allegation alleging Child was injured while in care due to lack of supervision. LPA contacted the Reporting Party (RP) and left voice messages on 06/09/22 and 06/16/22 for an interview for further details but RP did not call back. (Continue next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
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 6
Control Number 06-CC-20220608091112
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KELLIE'S ACADEMY FOR KIDS, CHILD DEV. CTR.
FACILITY NUMBER: 304370315
VISIT DATE: 08/16/2022
NARRATIVE
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(Page 2 of Report)

During the course of investigation, LPA Tran interviewed 4 staff and 5 children at the facility on 06/10/2022, and 2 staff and 3 children on 08/16/2022. LPA Tran also reviewed facility’s Sign In/Out sheets, staffing schedule, facility’s procedure regarding to injury and report.

During interviews, LPA Tran interviewed 4 staff and 5 children at the facility on 06/10/2022, and 2 staff and 3 children on 08/16/2022. All 6 out of 6 interviewed staff were consistent when giving answers about the facility’s procedures regarding injury and reporting to authorized representatives. The procedure is described as followed. Staff will immediately attend to child and assess the injury, provide first aids, complete an ouch report and inform Director if the injury is serious. Director will investigate the situation and if needed depending on severity of the injury, will call parents to inform them of the incident. All 4 out of 4 staff reported that, on 06/07/2022, at 10:37am, Child #1 (C1) got injured by another child, when C1 was in line, prior to transitioning from play yard into the classroom. Teacher immediately intervened, provided first aid to C1, informed the Director and completed the ouch report. Director was assisting another classroom and had planned to come to check up on C1 to see if needed, Director will contact the parents. Approximately 1 hour and 20 minutes later, without prior notice, parents arrived at 12pm to pick up C1 earlier than usual, which is around 4:30pm-5:30pm, before Director could assess the situation. On 06/10/2022, LPA Tran attempted to interview 5 children, 1 out of 5 children was qualified for the interview, child reported that teacher are always supervising and attend to their needs as needed. On 08/16/2022, LPA tran attempted to interview 3 children, none was qualified for an interview.

During record reviews, LPA Tran reviewed facility’s Sign In/Out sheets, staffing schedule, facility’s procedure regarding to injury and report. When reviewed Sign In/Out Sheets, LPA verified that parents did pick up child at 12pm which much sooner than usual pick up time, between 4:30pm-5:30pm, on the day of the incident. When reviewed staffing schedule, facility did have enough staff on the day of the incident, 5 teachers were supervising 37 children on the playground, and 2 staff members were responsible to supervise C1’s class which had 14 children on 06/07/2022. When reviewed facility’s procedure regarding injury and reporting requirements, LPA verified that facility staff followed the procedure and attended to child’s need. Although, Director could not assess child immediately to decide if a call was needed to inform parents, the Director did have a plan to assess the situation before calling parents to report about the incident, if needed, prior to the usual pick up time. (Continue next page)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20220608091112
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KELLIE'S ACADEMY FOR KIDS, CHILD DEV. CTR.
FACILITY NUMBER: 304370315
VISIT DATE: 08/16/2022
NARRATIVE
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(Page 3 of Report)

Based on the information gathered from LPA's interviews conducted with 4 staff and 5 children on 06/10/2022 and interviews with 2 staff and 3 children on 08/16/22, and record reviews facility’s Sign In/Out sheets, staffing schedule, and procedure regarding injury and report requirements, there is insufficient evidence to corroborate the allegation that Child was injured while in care due to lack of supervision, therefore, the allegation regarding Child was injured while in care due to lack of supervision is unsubstantiated.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to Administrator Darralynn VadeBoncoeur. First level appeal is to Regional Manager, address is above on the report.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6