Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197417385
Report Date: 06/22/2017
Date Signed 06/22/2017 02:28:27 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2017 and conducted by Evaluator Margarit Sislyan
COMPLAINT CONTROL NUMBER: 30-CC-20170407111907
FACILITY NAME:DEVONSHIRE PRESCHOOL AND INFANT CENTERFACILITY NUMBER:
197417385
ADMINISTRATOR:LORELL BATTERWORTHFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:43CENSUS: 20DATE:
06/22/2017
UNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:Lorell BatterworthTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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Margarit Sislyan, Licensing Program Analyst (LPA) arrived to the facility to continue the investigation of the
above allegation and deliver the investigation findings.
LPA met with Lorell Butherworht, Director/Owner.
In course of investigation LPA interviewed facility staff and reviewed the documentation relevant to the
allegations.
Licensee stated that there was an epidemic of Hand, Foot, and Mouth disease (HFMD).
The facility took appropriate measures to stop the epidemic and prevent further spreading of the
disease. Several children were infected. The last case of HFMD was reported on 4/7/17. No HFMD cases
reported since then.

Based on LPA’s observation, interviews and preponderance of evidence the above allegation is substantiated,
means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2017
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 30-CC-20170407111907

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DEVONSHIRE PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 197417385
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2017
Section Cited
101223(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

HFMD epidemic was reported at the facility.
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Licensee shall follow the health department's guidelines to prevent any communicable diseases.
The licensee shall develop and implement a written plan to prevent communicable diseases. The plan shall be submitted to CCLD.

POC date 07/22/17
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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.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2017
LIC9099 (FAS) - (06/04)
Page: 3 of 3