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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343601206
Report Date: 07/16/2021
Date Signed: 07/16/2021 11:02:50 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2021 and conducted by Evaluator Kelly Ferrara
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20210514144121
FACILITY NAME:ACTION DAY LEARNING CENTERFACILITY NUMBER:
343601206
ADMINISTRATOR:WOOD, CONNIEFACILITY TYPE:
840
ADDRESS:9371 ELM AVENUETELEPHONE:
(916) 988-9633
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:28CENSUS: 14DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Connie WoodTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff inappropriately grabbed child in care
INVESTIGATION FINDINGS:
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On July 16th, 2021 at 10:15 AM, Licensing Program Analyst (LPA) Kelly Ferrara conducted a follow up complaint investigation inspection and met with Director Connie Wood. LPA verified there were currently 14 school age children in care with one staff. During the investigation, LPA reviewed relevant documentation and conducted interviews with Reporting Party, Director, one parent, four children, and two staff.
It was alleged that Staff #1 grabbed Child #1 by the chin. Consistent statements were made during interviews that Staff #1 would use their fingers and thumb to take a child by the chin in order to gain their attention and establish eye contact. All parties interviewed revealed that they have observed Staff #1 do this on more than one occasion and with multiple children.
Based on the evidence obtained, the allegation is substantiated, meaning that preponderance of evidence standard has been met. See subsequent page for Type A deficiency cited for a personal rights violation. Exit interview was conducted and Notice of Site Visit was posted. The Director understands it must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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 03-CC-20210514144121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ACTION DAY LEARNING CENTER
FACILITY NUMBER: 343601206
VISIT DATE: 07/16/2021
NARRATIVE
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Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 9099 D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 03-CC-20210514144121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ACTION DAY LEARNING CENTER
FACILITY NUMBER: 343601206
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2021
Section Cited
CCR
101223(a)(1)
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Personal Rights- The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.:
This requirement was not met as evidenced by:
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Director stated that she will have staff sign a memo stating they have received the new "hands off policy". Director will also have all staff watch the Personal Rights video on the CCLD.CA.GOV website. Staff shall write a paragraph on their understanding of personal rights. Director shall submit the POC by COB Monday 7/19/21.
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Interviews revealed Staff #1 grabbed children by their chin in order to gain their attention and make eye contact on various occasions. This is 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: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3