<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376626459
Report Date: 12/08/2022
Date Signed: 12/08/2022 10:40:54 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2022 and conducted by Evaluator David Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20221014113355
FACILITY NAME:SMITH, ANGELA FAMILY CHILD CAREFACILITY NUMBER:
376626459
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Angela Smith TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee handled child in a rough manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/08/2022 at 10:15am, Licensing Program Analyst (LPAs) David Miller and Vicky Williamson conducted an inspection for the purpose of delivering findings for the above listed allegation. LPAs were led on a tour of the facility, and observed four (4) children and one (1)staff.

During the course of the investigation, interviews were conducted with complainant, licensee, staff, daycare children and parents. In addition, video surviellance was reviewed. The licensee stated that on or about August, 20th 2022 during a birthday party for a daycare child that she did grab two children and pulled tehm back to move them out of the way to give a performer room for their next activity.

Based on interviews, and video review, the preponderance of evidence standard has been met, that the licensee handled two chidlren in a rough manner by grabbing their arm and pulling backward in a rough manner on or about August 20th, 2022, therefore the above allegation is found to be SUBSTANTIATED, California Code of Regulations, (Title 22, Division 12 Chapter 3) are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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 3
Control Number 20-CC-20221014113355
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SMITH, ANGELA FAMILY CHILD CARE
FACILITY NUMBER: 376626459
VISIT DATE: 12/08/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA Miller informed the licensee to provide a copy of this licensing report dated (12/07/2022) that documents any Type A citation to the parents/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 (LIC 9224), or other written statement, must be placed in the child's file for verification. LPA provided the licensee, Angela Smith, LIC 9224 form.

The Notice of Site Visit (LIC 9213) and Appeals Rights (LIC 9058) were provided. LPA observed the LIC 9213 posted by the front door. An exit interview was conducted with the licensee, Angela Smith.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 20-CC-20221014113355
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SMITH, ANGELA FAMILY CHILD CARE
FACILITY NUMBER: 376626459
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2022
Section Cited
CCR
102423(a)(4)
1
2
3
4
5
6
7
102423(a): Each child receiving services from a family . . . have certain rights . . . These rights include, . . . (4)To be free from corporal or unusual punishment, infliction of pain. . . or other actions of a punitive nature, . . . to physical functioning.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that she will watch the personal rights video, review Title 22 Personal Rights and provide a written plan to ensure children's rights are not being violated by 12/13/2022

8
9
10
11
12
13
14
Based on interviews and video licensee did not comply with the above regulation as licensee grabbed and pulled two children in a rough manner, which poses an immediate health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3